Prediction of Preterm Delivery Based on Maternal Plasma Urocortin

Abstract

Summary P reterm birth, defined as childbirth occurring at less than37 completed weeks or 259 days of gestation, is a majordeterminant of neonatal mortality and morbidity and has longterm adverse consequences for health (Huddy et al., 2001). Estimation of preterm birth rates and, ideally, theirproper 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 complicationof 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 theearliest intervention possible. Urocortins (Ucns) are peptides showing sequencehomology with CRH; CRH and Ucn are ligands for CRH- type1 (CRH-R1) and type 2 (CRH-R2) receptors, whereas Ucn2 andUcn3 specifically bind only CRH-R2 (Aguilera et al., 2004).Ucns are expressed by gestational tissues such as trophoblastand fetal membranes (Imperatore et al., 2006). That is why, in this study, we had aimed to assess therole of measuring urocortin concentrations in maternal plasmaof women with threatened preterm labour. The difference in the urocorin levels between patients who deliver at term and thoselaboring and delivering preterm have been weighed. The aimwas to assess whether the measurement of urocortin may beclinically useful as a diagnostic predictor of preterm delivery inwomen with threatened preterm labour and if there is a cut-offvalue that can be of applicable clinical use. Our limited study showed that plasma urocortin canindeed be used as a predictive marker for preterm labour with agood predictive value as evidenced by a significant area underthe ROC curves. Our study helped us conclude that urocortincan be used as an independent factor or in combination withother statistically significant factors to help in the prediction ofpreterm delivery. Even after adjusting the study and taking intoconsideration other factors that could influence the area underthe curve, our study still showed high predictive powers for theurocortin as an independent factor for preterm deliveryprediction. Urocortin can influence the time to event (in ourcase, the time to preterm delivery).The fact that it can be obtained through a blood samplegives it high applicability.