Abstract
Alterations in endogenous progesterone metabolism associated with spontaneous very preterm delivery
Highlights
Preterm birth continues to be a significant global health problem
MAIN RESULTS AND THE ROLE OF CHANCE: Steroid hormone levels and pregnancy outcome data were available for 93 women; 28 delivering prior to 32 weeks, 40 delivering between 32 0/7 and 36 6/7 weeks and 25 delivering at or greater than 37 weeks: the mean gestational age at delivery within the three groups was 27.0, 34.4 and 38.8 weeks, respectively
Among women delivering spontaneously at less than 37 weeks, maternal 11-deoxycorticosterone (DOC) levels drawn in the late first trimester/early second trimester were significantly associated with spontaneous preterm delivery prior to 32 weeks; a threshold level of 47.5 pg/ml had 78% sensitivity, 73% specificity and an
Summary
1 in 10 pregnant women deliver prematurely in the USA, with worldwide rates rising up to 18% (World Health Organization, 2019). Those with very or extremely preterm delivery (less than 32 weeks’ and 28 weeks’ gestation, respectively) have the most severe complications and highest associated healthcare costs annually (World Health Organization, 2019). In the USA, preterm delivery less than 32 weeks is associated with an 80-fold increase in infant mortality compared to women delivering between 39 and 41 weeks’ gestation (175.5 versus 2.1 deaths per 1000 live births) (Mathews and MacDorman, 2012). Across the USA, the annual societal economic costs of preterm birth and associated care are estimated at $26 billion (Behrman and Butler, 2007). The lack of progress in reducing the rate of early preterm delivery has hampered efforts to improve downstream sequelae, including disparities in infant mortality rates
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