Profiling Amniotic Fluid Yields Faster Test For Infection And Preterm Birth Risk, Researchers Find

Diagnosing intra-amniotic inflammation or infection is crucial because these conditions can lead to the death of the fetus or other serious consequences of preterm birth, including brain damage, lung and bowel injury.

The study's authors were recognized by an award from the March of Dimes, marking the third year that the organization has honored SMFM members for cutting-edge prematurity research. The March of Dimes is conducting a multi-year, multi-million-dollar campaign aimed at reducing the growing rate of premature births through research and awareness.

"Our goal was to create a test that could more accurately predict which pregnancies with preterm labor are at risk for fetal complications from intrauterine inflammation/infection," said Catalin S. Buhimschi, M.D., of Yale University, the lead study author and SMFM member. "We found that profiling the proteins in amniotic fluid for markers of inflammation--a proteomic profile--not only yielded results twice as fast as other tests, but those results were also much more accurate. We discovered that the presence of fewer than two biomarkers for inflammation meant the median time for delivery was five to six days. If all the biomarkers for inflammation were present, delivery time was within hours."

"Research such as this is vital if we are to understand the basic mechanisms underlying preterm birth and find ways to prevent or treat it," said Nancy S. Green, M.D., medical director of the March of Dimes. "Dr. Buhimschi's work is exciting because it offers a potential new tool to identify women who are at highest risk for a preterm delivery. For these women, knowing their risk and managing it may lead to dramatic improvements in the health of their babies."

Each of the 135 study participants had presented at a hospital with premature labor symptoms and underwent a routine amniocentesis to determine the maturity of the fetus's lungs. A small sample of the amniotic fluid was also immediately analyzed by screening and diagnostic tests--glucose, neutrophil (white blood cell) count , lactate dehydrogenase (LDH), Gram stain, culture, IL-6 and MMP-8--and a "fingerprint" of the proteins was generated using SELDI-TOF (surface-enhanced laser desorption ionization time-of flight). Peaks were sought for four proteins that served as evidence of inflammation.

Results revealed that the proteomic profiling was more accurate, yielding results in 30 minutes and catching subtle inflammation missed by other tests such as the neutrophil count, Gram stain or culture.

The study, "Detection of Intra-amniotic Inflammation/Infection by Proteomic Profiling. Prospective Comparison with Rapid Diagnostic Tests (Glucose, WBC, LDH, Gram Stain,) IL-6 AND MMP-8," is the first to compare prospectively the traditional tests with the new proteomic profile using fresh amniotic fluid and is a joint effort by maternal-fetal medicine specialists from Yale University and the University of Kansas School of Medicine.

Proteomics is a novel technology that has found applications in various fields including cancer screening. Its potential for improving management of pregnancy complications also appears to be very promising.

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The Society for Maternal-Fetal Medicine (est. 1977) is a non-profit membership group for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by continuously educating its 2000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual scientific meeting in which new ideas and research in the area of maternal-fetal medicine are unveiled and discussed. For more information, visit http://www.smfm.org.

The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education, and advocacy. For more information, visit the March of Dimes Web site at http://www.marchofdimes.com or its Spanish language Web site at http://www.nacersano.org.