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Is thrombin activation predictive of subsequent preterm delivery?
Alex C Vidaeff1, Manju Monga, Susan M Ramin
1Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
American Journal of Obstetrics and Gynecology
|March 28, 2013
Summary
Elevated thrombin-antithrombin (TAT) complexes in early pregnancy are linked to preterm delivery. However, TAT levels alone are poor predictors of preterm birth risk.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
- Thrombosis Research
Background:
- Preterm delivery is a leading cause of neonatal morbidity and mortality.
- The etiopathogenesis of preterm delivery is complex and multifactorial.
- Thrombin generation, a key hemostatic process, has been implicated in pregnancy complications.
Purpose of the Study:
- To investigate the association between thrombin generation, measured by thrombin-antithrombin (TAT) complexes in amniotic fluid, and the risk of subsequent preterm delivery.
- To assess the discriminatory performance of TAT levels for predicting preterm birth.
Main Methods:
- A prospective cohort study of 731 women undergoing second-trimester amniocentesis.
- TAT complex levels were measured and analyzed continuously and by quartiles.
- Multivariable regression and receiver operating characteristic (ROC) curve analyses were employed.
Main Results:
- Women who delivered preterm exhibited significantly higher amniotic fluid TAT levels compared to those delivering at term (median 98.9 mcg/L vs. 66.3 mcg/L, P < .001).
- Elevated TAT levels were observed in both spontaneous and indicated preterm deliveries.
- The area under the ROC curve was 0.62, indicating poor discriminative ability of TAT for preterm delivery risk.
Conclusions:
- Second-trimester amniotic fluid TAT complex levels are elevated in women who subsequently experience preterm delivery.
- These findings suggest a potential role for thrombin generation in the mechanisms leading to preterm birth.
- Despite elevated levels, TAT concentration alone demonstrates limited utility as a predictive marker for preterm delivery.
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