Plasma Urocortin Level as a Predictor for Pre-term Delivery

Abstract

Preterm birth, defined as childbirth occurring at less than 37 completed weeks or 259 days of gestation, is a major determinant of neonatal mortality and morbidity and has long-term adverse consequences for health (Huddy et al., 2001). Estimation of preterm birth rates and, ideally, their proper categorization (e.g. spontaneous versus indicated) are essential for accurate determination of global incidence in order to inform policy and programmes on interventions to reduce the risk of premature labour and delivery (Pennel et al., 2007). Preterm labour is the single most important complication of pregnancy in the absence of congenital abnormality, as it is recognized as a worldwide problem responsible for more than 80% of neonatal deaths and more than 50% of long term morbidity in the surviving infants (Goldenberg et al., 2008). That is why early identification is essential to allow for the earliest intervention possible. Urocortins (Ucns) are peptides showing sequence homology with CRH; CRH and Ucn are ligands for CRH- type 1 (CRH-R1) and type 2 (CRH-R2) receptors, whereas Ucn2 and Ucn3 specifically bind only CRH-R2 (Aguilera et al., 2004). Ucns are expressed by gestational tissues such as trophoblast and fetal membranes (Imperatore et al., 2006). That is why, in this study, we had aimed to assess the role of measuring urocortin concentrations in maternal plasma of women with threatened preterm labour. The difference in the urocorin levels between patients who deliver at term and those laboring and delivering preterm have been weighed. The aim was to assess whether the measurement of urocortin may be clinically useful as a diagnostic predictor of preterm delivery in women with threatened preterm labour and if there is a cut-off value that can be of applicable clinical use. Our limited study showed that plasma urocortin can indeed be used as a predictive marker for preterm labour with a good predictive value as evidenced by a significant area under the ROC curves. Our study helped us conclude that urocortin can be used as an independent factor or in combination with other statistically significant factors to help in the prediction of preterm delivery. Those other factors that remarkably elevated the predictability and gave us more accuracy included taking into consideration are the cervical effacement upon diagnosis and the duration of tocolysis. Even after adjusting the study and taking into consideration other factors that could influence the area under the curve, our study still showed high predictive powers for the urocortin as an independent factor for preterm delivery prediction. Urocortin can influence the time to event (in our case, the time to preterm delivery). The fact that it can be obtained through a blood sample gives it high applicability.