Prevention of Preterm Birth

Jeffrey M. Denney; Jennifer F. Culhane; Robert L. Goldenberg

Disclosures

Women's Health. 2008;4(6):625-638. 

In This Article

Risk Assessment for Preterm Birth

Using standardized questionnaires in order to assess one's risk for a preterm birth has been included in many prematurity-prevention strategies. Overall, these scoring systems identified women with risk of preterm birth that was approximately double the so-called background risk; this relationship was predominantly a result of having a history of preterm birth.[26] Although these systems identify those at risk, their use has generally resulted in an increased use of interventions with no significant reduction in preterm birth rates.

There have been many attempts to use various biomarkers, either alone or in combination, to predict preterm birth.[27,28] Some of these, such as vaginal or cervical fetal fibronectin, when performed at approximately 24 weeks, even in a general population of pregnant women, are verypowerful predictors of preterm birth.[13,14] Serum corticotrophin-releasing factor, serum α-fetoprotein and many other proteins in amniotic fluid, serum, plasma, cervical fluid and vaginal fluid are also relatively strong predictors of preterm birth.[29] More recently, studies using proteomic methodology have identified additional proteins that predict preterm birth.[30,31] However, to date, knowledge of abnormal levels of these potential markers of preterm birth has not led to the development of an effective treatment strategy leading to a reduction in preterm birth. In addition, various genetic markers, now more commonly identified through microarrays, have been associated with preterm birth. Gene-environmental interactions, perhaps mediated by epigenetic associations, may also be important in the causation of preterm birth. While these findings are likely to be important in identifying pathways leading to preterm birth, to date, as with the proteins discussed above, their identification has not led to a treatment or intervention that reduces preterm birth.

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