Preterm Delivery Prediction Using Phosphorylated Insulin-Like Growth Factor in Rural Kenya [OP01-1A

Abstract

INTRODUCTION: To evaluate the feasibility and accuracy of a test analyzing for the presence of phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1), in predicting preterm delivery in asymptomatic women in the rural Kenya. METHODS: This was a prospective cohort study conducted by Saving Mothers from 2013-2019. Asymptomatic women presenting for routine prenatal care in West Pokot, Kenya were enrolled. Pregnant women were recruited prior to 24 weeks and offered the opportunity to return at 28-32 weeks gestation to obtain the phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1) assay. Dating was established by last menstrual period and confirmed by ultrasound. Patients who tested positive received betamethasone, and were referred to the maternity waiting home. Outcome data was collected after delivery and sensitivity, specificity, positive and negative predictive values were reported for the test. RESULTS: 669 women were recruited. 469 returned for the second visit to receive the test, and presently 370 have complete data for analysis. 180 tested positive for preterm birth risk, 143 of whom delivered prior to 37 weeks gestation (Positive Predictive Value = 79.4%). 190 tested negative, 176 of whom delivered after 37 weeks (Negative Predictive Value = 92.6%). Sensitivity for the test was 91.0%. Specificity was 82.6%. CONCLUSION: The pIGFBP-1 point of care test is effective in predicting risk for preterm birth in asymptomatic women in rural Kenya. This allows for risk-stratification in low resource settings. Proper intervention may optimize utilization of scarce resources and improve maternal and child health.