Prediction of Preterm Birth: Maternal Characteristics, Ultrasound Markers, and Biomarkers: An Updated Overview

Abstract

There is not a single or combined screening method for preterm birth with high sensitivity which will truly identify the women at risk for preterm birth while also with high specificity to prevent unnecessary interventions and high treatment costs. Measurement of cervical length is the most cost-effective method that is used in clinical practice. Bedside tests have also been developed for detecting markers like fetal fibronectin, insulin-like growth factor binding protein-1 (IGFBP-1), interleukin-6, and placental alpha-macroglobulin-1. Taking the maternal history, health condition, and sociodemographical factors into consideration is recommended. Ultrasound markers apart from cervical length measurements as uterocervical angle and placental strain ratio are studied. Investigations on metabolomics, proteomics, and microRNA profiling have brought a new aspect on this subject. Maybe in the future, with clear identification of women at true risk for preterm birth, development of more effective preventive strategies will not be unfeasible.

Uterocervical angle as a predictor of preterm birth on a high‐risk collective between 20 and 31 weeks of gestation: A cohort analysis

“…Biochemical point of care tests with measurement of fetal fibronectin (fFN), placental alpha‐microglobulin‐1 (PAMG‐1) or phosphorylated insulin‐like growth factor binding‐protein‐1 (phIGFBP‐1) in cervicovaginal fluid have been added in recent years to improve the prediction of PTB 4 . However, it is yet not clear what the optimal algorithm for the application of these new biochemical parameters will be – instead or in addition to the CL measurement 3 . Furthermore, a routine application of the commercial available kits will increase the financial burden with costs up to 50€ per test.…”

Adiponectin as a Potential Biomarker for Pregnancy Disorders

“…Two meta-analyses of 116 different biomarkers from 217 studies over a period of four decades [ 115 ] and 30 novel biomarkers investigated over ten years [ 116 ] concluded that none of the investigated biomarkers can be considered clinically useful to predict PTB. In recent years, biomarkers that have been actively investigated for PTB include epigenetics (DNA methylation, histone modifications and microRNAs) [ 117 ], novel ultrasound markers (uterine artery pulsatility index, placental strain ratio and anterior cervical angle), and cervicovaginal, amniotic fluid and serum markers such as adipokines [ 118 ]. Adipokines play an important role in maternal-foetal adaptions and as such their expression has been demonstrated to vary during pregnancy and pregnancy complications [ 53 , 54 , 55 ].…”

Nomogram to Early Screen Multiparous Women for Preterm Birth in a Cohort Study

“…However, screening for PTB remains difficult in the absence of specific tests that would identify potential mothers at high risk of preterm birth. Although, the cervical length and cervico-vaginal fetal fibronectin measurements have been used with some success [5]. In addition, recent meta-analyses show there is no effective risk scoring system for prediction of PTB [6].…”