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Cervical phosphorylated insulin-like growth factor binding protein-1 test for the prediction of preterm birth: a
Agustin Conde-Agudelo1, Roberto Romero2
1Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI.
Insights
The cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) test has limited accuracy for predicting preterm birth in both symptomatic and asymptomatic women. However, a negative phIGFBP-1 result may help identify women in labor unlikely to deliver within 48 hours.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
- Clinical Diagnostics
Background:
- Preterm birth is a leading cause of neonatal morbidity and mortality.
- Accurate prediction of preterm birth is crucial for timely intervention and improved neonatal outcomes.
- Cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) has been investigated as a potential biomarker for preterm birth prediction.
Purpose of the Study:
- To systematically review and meta-analyze the predictive accuracy of the cervical phIGFBP-1 test for preterm birth.
- To assess the test's performance in women with and without symptoms of preterm labor.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, Embase, Cinahl, Lilacs, Medion) up to June 30, 2015.
- Included were cohort and cross-sectional studies reporting on the predictive accuracy of cervical phIGFBP-1 for preterm birth.
- Data were independently extracted by two reviewers, and meta-analytic techniques, including summary receiver-operating characteristic curves, were used to synthesize findings.
Main Results:
- Forty-three studies involving 10,203 women were analyzed.
- In asymptomatic women, the test showed minimal predictive accuracy for preterm birth at various gestational ages.
- In women with preterm labor symptoms, the test demonstrated low predictive performance for delivery within 7-14 days and for preterm birth at <34 and <37 weeks.
Conclusions:
- The cervical phIGFBP-1 test has limited overall predictive ability for identifying women at risk of preterm birth.
- The test may have potential utility in identifying women in preterm labor who are unlikely to deliver within 48 hours.
Objective:
To assess the accuracy of the cervical phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) test to predict preterm birth in women with and without symptoms of preterm labor through the use of formal methods for systematic reviews and metaanalytic techniques.
Data Sources:
PubMed, Embase, Cinahl, Lilacs, and Medion (all from inception to June 30, 2015), reference lists, conference proceedings, and Google scholar.
Study Eligibility Criteria:
Cohort or cross-sectional studies that reported on the predictive accuracy of the cervical phIGFBP-1 test for preterm birth.
Study Appraisal And Synthesis Methods:
Two reviewers independently selected studies, assessed the risk of bias, and extracted the data. Summary receiver-operating characteristic curves, pooled sensitivities and specificities, and summary likelihood ratios were generated.
Results:
Forty-three studies met the inclusion criteria, of which 15 provided data on asymptomatic women (n = 6583) and 34 on women with an episode of preterm labor (n = 3620). Among asymptomatic women, the predictive accuracy of the cervical phIGFBP-1 test for preterm birth at <37, <34, and <32 weeks of gestation was minimal, with pooled sensitivities and specificities and summary positive and negative likelihood ratios ranging from 14% to 47%, 76% to 93%, 1.5 to 4.4, and 0.6 to 1.0, respectively. Among women with an episode of preterm labor, the test had a low predictive performance for delivery within 7 and 14 days of testing, and preterm birth at <34 and <37 weeks of gestation with pooled sensitivities and specificities and summary positive and negative likelihood ratios that varied between 60% and 68%, 77% and 81%, 2.7 and 3.5, and 0.4 and 0.5, respectively. A negative test result in women with an episode of preterm labor had a low to moderate accuracy to identify women who are not at risk for delivering within the next 48 hours (summary negative likelihood ratio of 0.28 in all women and 0.23 in women with singleton gestations).
Conclusion:
Cervical phIGFBP-1 has the potential utility to identify patients with an episode of preterm labor who will not deliver within 48 hours. However, its overall predictive ability for the identification of symptomatic and asymptomatic women at risk for preterm birth is limited.
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