Assessment of current biomarkers and interventions to identify and treat women at risk of preterm birth

被引:1
|
作者
Gravett, Michael G. [1 ]
Menon, Ramkumar [2 ]
Tribe, Rachel M. [3 ]
Hezelgrave, Natasha L. [4 ]
Kacerovsky, Marian [5 ,6 ]
Soma-Pillay, Priya [7 ]
Jacobsson, Bo [8 ,9 ]
McElrath, Thomas F. [10 ,11 ]
机构
[1] Univ Washington, Dept Obstet & Gynecol & Global Hlth, Seattle, WA 98195 USA
[2] Univ Texas Med Branch Galveston, Dept Obstet & Gynecol, Galveston, TX USA
[3] Kings Coll London, Fac Life Sci & Med, Sch Life Course Sci, Dept Women & Childrens Hlth, St Thomas Hosp Campus, London, England
[4] Kings Coll London, Fac Life Sci & Med, Sch Life Course Sci, Dept Women & Childrens Hlth, London, England
[5] Univ Hosp Hradec Kralove, Biomed Res Ctr, Hradec Kralove, Czech Republic
[6] Charles Univ Prague, Fac Med Hradec Kralove, Dept Obstet & Gynecol, Hradec Kralove, Czech Republic
[7] Univ Pretoria, Dept Obstet & Gynaecol, Sch Med, Pretoria, South Africa
[8] Gothenburg Univ, Sahlgrenska Acad, Dept Obstet & Gynecol, Gothenburg, Sweden
[9] Norwegian Inst Publ Hlth, Dept Genet & Bioinformat, Domain Hlth Data & Digitalizat, Oslo, Norway
[10] Brigham & Womens Hosp, Dept Obstet & Gynecol, Boston, MA USA
[11] Harvard Med Sch, Boston, MA USA
关键词
preterm birth; biomarkers; screening tools; interventions; limitations; QUANTITATIVE FETAL FIBRONECTIN; ACTIM PARTUS TEST; CERVICAL LENGTH; SINGLETON PREGNANCY; GESTATIONAL-AGE; COMMUNICATION; METAANALYSIS; VALIDATION; PREVENTION; PREDICTION;
D O I
10.3389/fmed.2024.1414428
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Preterm birth remains an important global problem, and an important contributor to under-5 mortality. Reducing spontaneous preterm birth rates at the global level will require the early identification of patients at risk of preterm delivery in order to allow the initiation of appropriate prophylactic management strategies. Ideally these strategies target the underlying pathophysiologic causes of preterm labor. Prevention, however, becomes problematic as the causes of preterm birth are multifactorial and vary by gestational age, ethnicity, and social context. Unfortunately, current screening and diagnostic tests are non-specific, with only moderate clinical risk prediction, relying on the detection of downstream markers of the common end-stage pathway rather than identifying upstream pathway-specific pathophysiology that would help the provider initiate targeted interventions. As a result, the available management options (including cervical cerclage and vaginal progesterone) are used empirically with, at best, ambiguous results in clinical trials. Furthermore, the available screening tests have only modest clinical risk prediction, and fail to identify most patients who will have a preterm birth. Clearly defining preterm birth phenotypes and the biologic pathways leading to preterm birth is key to providing targeted, biomolecular pathway-specific interventions, ideally initiated in early pregnancy Pathway specific biomarker discovery, together with management strategies based on early, mid-, and-late trimester specific markers is integral to this process, which must be addressed in a systematic way through rigorously planned biomarker trials.
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页数:10
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