Tracy A Manuck1, M Sean Esplin2, Joseph Biggio3, Radek Bukowski4, Samuel Parry5, Heping Zhang6, Hao Huang6, Michael W Varner2, William Andrews3, George Saade4, Yoel Sadovsky7, Uma M Reddy8, John Ilekis8. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT. Electronic address: tmanuck@med.unc.edu. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, UT. 3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Center for Women's Reproductive Health, University of Alabama at Birmingham School of Medicine, Birmingham, AL. 4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX. 5. Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA. 6. Collaborative Center for Statistics in Science, Yale University School of Public Health, New Haven, CT. 7. Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA. 8. Pregnancy and Perinatology Branch, Center for Developmental Biology and Perinatal Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
Abstract
OBJECTIVE: Spontaneous preterm birth (SPTB) is a complex condition that is likely a final common pathway with multiple possible causes. We hypothesized that a comprehensive classification system appropriately could group women with similar STPB causes and could provide an explanation, at least in part, for the disparities in SPTB that are associated with race and gestational age at delivery. STUDY DESIGN: This was a planned analysis of a multicenter, prospective study of singleton SPTBs. Women with SPTB at <34 weeks' gestation were included. We defined 9 potential SPTB phenotypes based on clinical data: infection/inflammation, maternal stress, decidual hemorrhage, uterine distention, cervical insufficiency, placental dysfunction, premature rupture of the membranes, maternal comorbidities, and familial factors. Each woman's condition was evaluated for each phenotype. Delivery gestational age was compared between those with and without each phenotype. Phenotype profiles were also compared between women with very early (20.0-27.9 weeks' gestation) SPTB vs those with early SPTB (28.0-34.0 weeks' gestation) and between African American and white women. Statistical analysis was by t test and χ(2) test, as appropriate. RESULTS: The phenotyping tool was applied to 1025 women with SPTBs who delivered at a mean 30.0 ± 3.2 (SD) weeks' gestation. Of these, 800 women (78%) had ≥2 phenotypes. Only 43 women (4.2%) had no phenotypes. The 281 women with early SPTBs were more likely to have infection/inflammation, decidual hemorrhage, and cervical insufficiency phenotypes (all P ≤ .001). African American women had more maternal stress and cervical insufficiency but less decidual hemorrhage and placental dysfunction compared with white women (all P < .05). Gestational age at delivery decreased as the number of phenotypes that were present increased. CONCLUSION: Precise SPTB phenotyping classifies women with SPTBs and identifies specific differences between very early and early SPTB and between African American and white women.
OBJECTIVE: Spontaneous preterm birth (SPTB) is a complex condition that is likely a final common pathway with multiple possible causes. We hypothesized that a comprehensive classification system appropriately could group women with similar STPB causes and could provide an explanation, at least in part, for the disparities in SPTB that are associated with race and gestational age at delivery. STUDY DESIGN: This was a planned analysis of a multicenter, prospective study of singleton SPTBs. Women with SPTB at <34 weeks' gestation were included. We defined 9 potential SPTB phenotypes based on clinical data: infection/inflammation, maternal stress, decidual hemorrhage, uterine distention, cervical insufficiency, placental dysfunction, premature rupture of the membranes, maternal comorbidities, and familial factors. Each woman's condition was evaluated for each phenotype. Delivery gestational age was compared between those with and without each phenotype. Phenotype profiles were also compared between women with very early (20.0-27.9 weeks' gestation) SPTB vs those with early SPTB (28.0-34.0 weeks' gestation) and between African American and white women. Statistical analysis was by t test and χ(2) test, as appropriate. RESULTS: The phenotyping tool was applied to 1025 women with SPTBs who delivered at a mean 30.0 ± 3.2 (SD) weeks' gestation. Of these, 800 women (78%) had ≥2 phenotypes. Only 43 women (4.2%) had no phenotypes. The 281 women with early SPTBs were more likely to have infection/inflammation, decidual hemorrhage, and cervical insufficiency phenotypes (all P ≤ .001). African American women had more maternal stress and cervical insufficiency but less decidual hemorrhage and placental dysfunction compared with white women (all P < .05). Gestational age at delivery decreased as the number of phenotypes that were present increased. CONCLUSION: Precise SPTB phenotyping classifies women with SPTBs and identifies specific differences between very early and early SPTB and between African American and white women.
Authors: Michael S Kramer; Aris Papageorghiou; Jennifer Culhane; Zulfiqar Bhutta; Robert L Goldenberg; Michael Gravett; Jay D Iams; Agustin Conde-Agudelo; Sarah Waller; Fernando Barros; Hannah Knight; Jose Villar Journal: Am J Obstet Gynecol Date: 2011-10-25 Impact factor: 8.661
Authors: Robert L Goldenberg; Michael G Gravett; Jay Iams; Aris T Papageorghiou; Sarah A Waller; Michael Kramer; Jennifer Culhane; Fernando Barros; Augustin Conde-Agudelo; Zulfiqar A Bhutta; Hannah E Knight; Jose Villar Journal: Am J Obstet Gynecol Date: 2011-10-25 Impact factor: 8.661
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Authors: Jose Villar; Aris T Papageorghiou; Hannah E Knight; Michael G Gravett; Jay Iams; Sarah A Waller; Michael Kramer; Jennifer F Culhane; Fernando C Barros; Agustín Conde-Agudelo; Zulfiqar A Bhutta; Robert L Goldenberg Journal: Am J Obstet Gynecol Date: 2011-10-25 Impact factor: 8.661
Authors: Olivia R Orta; Shelley S Tworoger; Kathryn L Terry; Brent A Coull; Bizu Gelaye; Clemens Kirschbaum; Sixto E Sanchez; Michelle A Williams Journal: Stress Date: 2018-12-26 Impact factor: 3.493
Authors: Prakesh S Shah; Sarah D McDonald; Jon Barrett; Anne Synnes; Kate Robson; Jonathan Foster; Jean-Charles Pasquier; K S Joseph; Bruno Piedboeuf; Thierry Lacaze-Masmonteil; Karel O'Brien; Sandesh Shivananda; Nils Chaillet; Petros Pechlivanoglou Journal: CMAJ Open Date: 2018-01-18
Authors: M Sean Esplin; Tracy A Manuck; Michael W Varner; Bryce Christensen; Joseph Biggio; Radek Bukowski; Samuel Parry; Heping Zhang; Hao Huang; William Andrews; George Saade; Yoel Sadovsky; Uma M Reddy; John Ilekis Journal: Am J Obstet Gynecol Date: 2015-06-09 Impact factor: 8.661
Authors: Shannon L Gillespie; Lisa M Christian; Angela D Alston; Pamela J Salsberry Journal: Psychoneuroendocrinology Date: 2017-06-15 Impact factor: 4.905