Key result
First-trimester model combining HtrA1, BMI, and physical activity predicts spontaneous preterm birth with 0.83 AUC.
Why the study?
The potential of maternal plasma HtrA1 concentration in the first trimester to identify women at risk for spontaneous preterm birth was not established.
Does maternal plasma HtrA1 level at 12 weeks of gestation predict spontaneous preterm birth in pregnant women?
Cohort (n=159)
Does maternal plasma HtrA1 level at 12 weeks of gestation predict spontaneous preterm birth in pregnant women?
Effect estimate: AUC 0.83 (95% CI 0.73-0.91)
Maternal plasma HtrA1 at 12 weeks of gestation, combined with BMI and physical activity, may serve as a predictive marker for spontaneous preterm birth.
May inform preterm birth risk tools if validated; leaves open prospective confirmation before clinical adoption.
OBJECTIVES: High temperature requirement A1 (HtrA1) is a serine protease detected in maternal plasma and in placental tissues during normal gestation and in various pathological conditions. The purpose of this study was to determine whether the maternal plasma concentration of HtrA1 in first trimester, alone or combined with other maternal factors, can be used to identify women at risk for spontaneous preterm birth (SPTB). STUDY DESIGN: This is a cohort study on pregnant women at 12 weeks of gestation recruited between 2014 and 2016 and prospectively followed until delivery. One hundred and fifty-nine women were included in the study: 140 women delivered at term and 19 (11.9%) delivered spontaneously preterm. Plasma samples were assessed for HtrA1 by ELISA and data were compared between women which delivered at term with women which delivered preterm. A multiple logistic regression analysis was used to estimate the independent effect of women's characteristics on the probability of a SPTB. RESULTS: SPTB was significantly associated with log HtrA1 values at 12 weeks of gestation, BMI before pregnancy and physical activity. In particular, the probability of a SPTB increases of 79% for every added unit of log HtrA1, while decreases of 18% for every added unit of BMI. In addition, physical activity was found as an important protective factor. The ROC curve showed that the model had a good accuracy in predicting SPTB, with an AUC equal to 0.83 (95%CI: 0.73-0.91). CONCLUSIONS: Maternal plasma HtrA1 may be considered a marker of SPTB. In addition, our model indicates two factors that could be modified to reduce the risk of SPTB, i.e. BMI before pregnancy and maternal physical activity.
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Giannubilo et al. (2020) conducted a cohort in Pregnancy (n=159). First trimester maternal plasma HtrA1 level vs. Lower HtrA1 levels was evaluated on Spontaneous preterm birth (SPTB) (AUC 0.83, 95% CI 0.73-0.91). A predictive model including first trimester maternal plasma HtrA1 levels, pre-pregnancy BMI, and physical activity accurately predicted spontaneous preterm birth (AUC 0.83; 95% CI 0.73-0.91).
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