Abstract
It is estimated that every year fifteen million premature babies are born worldwide mainly due to spontaneous preterm birth (sPTB). Furthermore, in clinical settings, there still are no reliable and accurate tools to predict preterm labor. Hence, the aim of this pioneering research was to estimate the relationship between the maternal inflammatory indicator and sPTB in a case-control study between 220 South Bulgarian women. The study was conducted at UMBAL, Stara Zagora, Bulgaria (2017-2020) and enrolled a total of 220 women, determined into two groups: 1) TB (n = 110), who were to give birth at term ≥ 37 to ≤ 39 + 6 gestation weeks with active labor at the time of hospitalization; and 2) sPTB (n = 110), women with preterm birth ≤ 32–34 + 6 gestation weeks and declared active labor, who were to give birth within 5-24 hrs. The inflammatory indicators/CRP concentration was quantified in plasma by immunoturbidimetric methods within 2 hrs. in mg/l. The median maternal CRP (8.77 ± 3.91), with cutoff = 4.9 mg/l was identified as optimal inflammation with highest risk of sPTB (sensitivity = 86.6%; specificity = 53.7%, р < 0.0001). Moreover, a cutoff CRP = 4.9 mg/l was found to be most effective in determining maternal age ≤ 19 years, the sensitivity of 68.6%, and positively correlated OR = 8.122 vs. OR = 2.354, with increased total sPTB risk at ≤ 32-34 + 6 weeks, respectively (p < 0.001).
 In conclusion, increased CRP concentrations and a decreased maternal age were associated with increased risks of sPTB, before ≤ 32-34 + 6 weeks. Minimal inflammation and other factors in combination may also act as sPTB prognosis.
Highlights
Spontaneous preterm birth remains a socially significant problem globally just as in Bulgaria
Premature births are categorized into two major types depending on their main cause: 1) Idiopathic spontaneous premature birth (70-80%); there is declared labor with preserved integrity of the amniotic membranes (40-50%), or birth begins after premature ejaculation of the amniotic sac without declared labor (25-40%); 2) Artificially induced premature birth (20-30%); it is declared by induction of labor or by caesarean section according to the indications of the mother or fetus before the end of the 37 gestational weeks, as mentioned by Menon (2008)
We evaluated the associations between maternal plasmatic C-reactive protein (CRP) concentrations and sPTB by using logistic regression receiving operating characteristic (ROC) curve to determine the best cut-off point for plasmatic CRP
Summary
Spontaneous preterm birth (sPТB) remains a socially significant problem globally just as in Bulgaria. According to Menon (2019), the main etiological cause of premature birth is considered to be the ascending bacterial infection of the amniotic membranes, amniotic fluid, placenta, umbilical cord, and fetus. There is a possibility of "sterile" inflammation in them too, which can be found in cases of premature birth with intact amniotic membranes It is an expression of the non-specific defense mechanism in cellular stress, cell death (Almskaar 2019), and even leads to perinatal death. To better understand the changes in maternal autoimmunity during pregnancy and to find a marker for risk observation, we broke new ground by measuring CRP concentrations collected in ≤ 32–34+6 gestational weeks and by calculating the relationship between plasmatic inflammation and spontaneous PTB in a prospective case-control study in South Bulgarian women
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