孕期血清学指标预测不良妊娠结局?难度大!
创作:Epi汪 审核:Epi汪 2022年06月04日
  • 纳入10038名初产妇数据,其中早产800例、先兆子痫568例、小于胎龄儿406例、死产49例;
  • 分别检测孕6-13周、16-21周母亲血清中血管内皮生长因子、胎盘生长因子、可溶性fms样酪氨酸激酶、抑制素A、甲胎蛋白等多种胎盘蛋白水平;
  • 虽然有部分指标在发生不良妊娠结局的孕妇中有变化,但变化均较小,并且都无法独立作为不良妊娠结局的预测因素;
  • 即使在结合了孕产妇基线信息后,加上血清学指标信息,也无法构造可行的不良妊娠结局预测模型。
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早期识别不良妊娠结局风险对临床上尽早实施干预,降低疾病风险具有重要意义。然而,目前并没有很准确的不良妊娠结局预测模型。本研究基于此,对孕期连续的血清中的多种胎盘相关的蛋白水平进行检测,虽然通过巢式病例对照设计,看到了不良妊娠结局的女性中这些指标可能存在统计学差异,但是这种差异均较小,并且都不足以构建有效的评估预测模型。因此,想要预测不良妊娠结局,道阻且长。
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Placental protein levels in maternal serum are associated with adverse pregnancy outcomes in nulliparous patients

母亲血清中的胎盘蛋白水平与初产妇的不良妊娠结局相关

10.1016/j.ajog.2022.03.064

2022-04-26, Article

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BACKGROUND: The Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be was established to investigate the underlying causes and pathophysiological pathways associated with adverse pregnancy outcomes in nulliparous gravidas.
OBJECTIVE: This study aimed to study placental physiology and identify novel biomarkers concerning adverse pregnancy outcomes, including preterm birth (medically indicated and spontaneous), preeclampsia, small-for-gestational-age neonates, and stillbirth. We measured levels of placental proteins in the maternal circulation in the first 2 trimesters of pregnancy.
STUDY DESIGN: Maternal serum samples were collected at 2 study visits (6-13 weeks and 16-21 weeks), and levels of 9 analytes were measured. The analytes we measured were vascular endothelial growth factor, placental growth factor, endoglin, soluble fms-like tyrosine kinase-1, A disintegrin and metalloproteinase domain-containing protein 12, pregnancy-associated plasma protein A, free beta-human chorionic gonadotropin, inhibin A, and alpha-fetoprotein. The primary outcome was preterm birth between 20 0/7 and 36 6/7 weeks of gestation. The secondary outcomes were spontaneous preterm births, medically indicated preterm births, preeclampsia, small-for-gestational-age neonates, and stillbirth.
RESULTS: A total of 10,038 eligible gravidas were enrolled in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort, from which a nested case-control study was performed comparing 800 cases with preterm birth (466 spontaneous preterm births, 330 medically indicated preterm births, and 4 unclassified preterm births), 568 with preeclampsia, 406 with small-for-gestational-age birth, and 49 with stillbirth with 911 controls who delivered at term without complications. Although levels of each analyte generally differed between cases and controls at 1 or 2 visits, the odds ratios revealed a <2-fold difference between cases and controls in all comparisons. Receiver operating characteristic curves, generated to determine the relationship between analyte levels and preterm birth and the other adverse pregnancy outcomes, resulted in areas under the receiver operating characteristic curves that were relatively low (range, 0.50-0.64) for each analyte. Logistic regression modeling demonstrated that areas under the receiver operating characteristic curves for predicting adverse pregnancy outcomes were greater using baseline clinical characteristics and combinations of analytes than baseline characteristics alone, but areas under the receiver operating characteristic curves remained relatively low for each outcome (range, 0.65-0.78).
CONCLUSION: We have found significant associations between maternal serum levels of analytes evaluated early in pregnancy and subsequent adverse pregnancy outcomes in nulliparous gravidas. However, the test characteristics for these analytes do not support their use as clinical biomarkers to predict adverse pregnancy outcomes, either alone or in combination with maternal clinical characteristics.

First Authors:
Samuel Parry

Correspondence Authors:
Samuel Parry

All Authors:
Samuel Parry,Benjamin A Carper,William A Grobman,Ronald J Wapner,Judith H Chung,David M Haas,Brian Mercer,Robert M Silver,Hyagriv N Simhan,George R Saade,Uma M Reddy,Corette B Parker,

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