A cohort study found that white blood cell count and endocrine markers predicted preterm birth in symptomatic women

Abstract

ObjectiveThis cohort study investigated potential clinical and biochemical predictors of subsequent preterm birth in women presenting with threatened preterm labor. Study design and settingSubjects were 218 pregnant women admitted to hospital with a diagnosis of threatened preterm labor at 22–36 weeks gestation. Exclusion criteria were multiple pregnancy, fetal anomalies, diabetes mellitus, abruptio placenta, preeclampsia, intrauterine growth restriction, cervical dilatation>4 cm, and clinical signs of infection. Analyses used logistic regression. ResultsThe presence of ruptured membranes was the best predictor of birth within 48 hours. Other important predictors were maternal white blood cell count at 22–27 weeks gestation and maternal adrenocorticotropin and corticotropin-releasing hormone concentrations at 28–36 weeks gestation. ConclusionSubclinical infection may be an important etiologic factor in preterm births of gestational age < 28 weeks. For those at ≥28 weeks gestation, the findings support the etiologic role of activation of the fetal and/or maternal hypothalamic pituitary adrenal axis leading to preterm birth.