One in 10 mothers give birth prematurely, a biological mystery that often comes with little warning and a sideshow of dangerous health repercussions. Doctors historically have had little luck predicting which women will deliver early, but now a new study presents a way to detect more than 80% of preterm births ahead of time, with a second-trimester blood test.
Researchers at Brigham Young University and the University of Utah identified three new peptide biomarkers that can forecast the likelihood of preterm birth when analyzed with other proteins. Peptides are short proteins that are composed of amino acids, as are ordinary proteins.
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Realizing that a way of assessing risk for preterm birth could be game-changing, the universities patented the method for detecting the peptides; it has been licensed to a company called Sera Prognostics. Within a year, the company plans to roll out a diagnostic test that physicians can use in their offices.
Pregnant patients can volunteer for the blood draw; they would not have to pay since the initial testing would be considered part of the approval process mandated by the U.S. Food and Drug Administration to confirm that the method effectively predicts preterm birth.
In the current study, which appears in the May issue of the American Journal of Obstetrics & Gynecology, researchers collected blood from 80 women who delivered prematurely and 80 who had full-term babies.
They found dramatically lower levels of the biomarkers in the women who delivered prematurely. Women were tested at 24 and 28 weeks of pregnancy. At 24 weeks, women who displayed lower peptide levels went on to have labor symptoms like contractions and dilation early, eight weeks later; when tested at 28 weeks, decreased levels predicted labor symptoms four weeks later. For women 28 weeks along, the peptides alone identified 65% of those who went on to deliver early; when combined with other proteins, the rate rose to 87%.
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And the closer a woman was to delivering prematurely, the more dramatic the reductions in her biomarkers — despite displaying no signs or symptoms of premature labor. “These women felt and looked fine to their doctors, but their markers had changed,” says Steven Graves, a professor of chemistry and biochemistry at Brigham Young University who directed the research.
The possibility of a widely available test to predict prematurity is “an extremely important set of discoveries,” says Michael Katz, the senior vice president of research and global programs at the March of Dimes and professor emeritus of pediatrics at Columbia University.
Pregnant women, who are poked and prodded enough as is, will be happy to learn that this blood draw could be combined with the sample taken to screen for gestational diabetes between 26 to 28 weeks of pregnancy. “It would be very simple to add this test to that blood draw,” says Graves. “Currently there are no tests to indicate a woman is at risk for preterm birth. Right now, a doctor is required to bring a woman in every few weeks to be examined in his office in an effort to catch changes that might be an indication of preterm labor.”
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Simply knowing that a woman is at high risk of premature birth won’t necessarily prevent it. But an at-risk woman can take precautions, such as limiting activity or going on bed rest. There are also drugs, such as the much-publicized Makena, a type of progesterone that can delay preterm labor in some pregnant women.
“The process by which labor begins has been shrouded in mystery,” says Katz. “The more of these discoveries we learn about, the more we will be able to make sense of these predictions. Eventually, all of this will fall into place.”