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[Preterm birth prediction: sequential evaluation of the cervix and the test for phosphorylated protein-1 linked to
Insights
Sequential testing of cervical length and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) effectively predicts preterm birth. Combining these tests offers high sensitivity and negative predictive value for identifying at-risk pregnancies.
Area of Science:
- Maternal-fetal medicine
- Obstetric ultrasound
- Biomarker analysis
Context:
- Preterm birth remains a leading cause of neonatal morbidity and mortality.
- Accurate prediction of preterm birth is crucial for timely intervention and improved outcomes.
- Asymptomatic pregnant women with a history of premature delivery are at increased risk.
Purpose:
- To evaluate the predictive utility of sequential cervical length measurements and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) testing for preterm birth.
- To assess the correlation between these two diagnostic tests.
- To determine the combined efficacy of these tests in predicting delivery before 37 weeks' gestation.
Summary:
- Cervical length measurement demonstrated high sensitivity in predicting preterm birth across all evaluated gestational ages.
- The phIGFBP-1 test became predictive of prematurity from 27 weeks onwards.
- The sequential combination of cervical length and phIGFBP-1 testing significantly enhanced sensitivity (81.8%) and negative predictive value (93.7%) compared to individual tests.
Impact:
- The combined sequential assessment of cervical length and phIGFBP-1 offers a robust strategy for predicting preterm birth.
- This approach can aid clinicians in identifying high-risk pregnancies, enabling targeted management and potentially reducing adverse neonatal outcomes.
- The findings support the integration of these sequential tests into routine prenatal care for women with a history of preterm delivery.
Purpose:
To investigate the usefulness of the measurement of cervical length and of the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) performed sequentially in the prediction of preterm birth and the correlation between tests.
Methods:
We analyzed data from 101 asymptomatic pregnant women with a history of premature delivery. The ultrasound measurement of cervical length and phIGFBP-1 test were performed in parallel every three weeks, between 24 and 34 week. The best cutoff value for each cervical evaluation was established by the ROC curve, and the two tests were compared using nonparametric tests. We determined the sensitivity, specificity and predictive values of each test and of the association of the exams for the occurrence of delivery before the 37th weeks.
Results:
There were 25 preterm births (24.8%). The cervix length showed the highest sensitivity and was able to predict preterm birth in all evaluations, with similar accuracy at different gestational ages. The test for phIGFBP-1 was not helpful at 24 weeks, but was able to predict prematurity when performed at 27, 30 and 33 weeks. The combination of tests increased the sensitivity (81.8%) and negative predictive value (93.7%) when compared to the separate use of each test. The mean cervical length was lower in women with a positive test.
Conclusions:
Both cervical length and the test for phIGFBP-1 were able to predict premature delivery, and sequential combination of both tests showed a high sensitivity and high negative predictive value.
