Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysis
Article first published online: 15 MAR 2011
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 118, Issue 9, pages 1042–1054, August 2011
How to Cite
Conde-Agudelo, A., Papageorghiou, A., Kennedy, S. and Villar, J. (2011), Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 1042–1054. doi: 10.1111/j.1471-0528.2011.02923.x
- Issue published online: 12 JUL 2011
- Article first published online: 15 MAR 2011
- Accepted 18 January 2011. Published Online 15 March 2011.
- preterm birth;
- systematic review
Please cite this paper as: Conde-Agudelo A, Papageorghiou A, Kennedy S, Villar J. Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysis. BJOG 2011;118:1042–1054.
Background Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies and help in understanding the pathways that lead to preterm birth.
Objective To investigate the accuracy of novel biomarkers to predict spontaneous preterm birth in women with singleton pregnancies and no symptoms of preterm labour.
Search strategy Electronic searches in PubMed, Embase, Cinahl, Lilacs, and Medion, references of retrieved articles, and conference proceedings. No language restrictions were applied.
Selection criteria Observational studies that evaluated the accuracy of biomarkers proposed in the last decade to predict spontaneous preterm birth in asymptomatic women. We excluded studies in which biomarkers were evaluated in women with preterm labour.
Data collection and analysis Two reviewers independently extracted data on study characteristics, quality, and accuracy. Data were arranged in 2 × 2 contingency tables and synthesised separately for spontaneous preterm birth before 32, 34, and 37 weeks of gestation. We used bivariate meta-analysis to estimate pooled sensitivities and specificities, and calculated likelihood ratios (LRs).
Main results A total of 72 studies, including 89 786 women and evaluating 30 novel biomarkers, met the inclusion criteria. Only three biomarkers (proteome profile and prolactin in cervicovaginal fluid, and matrix metalloproteinase-8 in amniotic fluid) had positive LRs > 10. However, each of these biomarkers was evaluated in only one small study. Four biomarkers had a moderate predictive accuracy (interleukin-6 and angiogenin, in amniotic fluid; human chorionic gonadotrophin and phosphorylated insulin-like growth factor binding protein-1, in cervicovaginal fluid). The remaining biomarkers had low predictive accuracies.
Conclusions None of the biomarkers evaluated in this review meet the criteria to be considered a clinically useful test to predict spontaneous preterm birth. Further large, prospective cohort studies are needed to evaluate promising biomarkers such as a proteome profile in cervicovaginal fluid.