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A novel prenatal index predicting the probability of neonatal intensive care in pregnants: amnion progesterone receptor to alfa fetoprotein rate
, 2, 3, 4, 5, 6
Affiliations- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Türkiye
- Department of Obstetrics and Gynecology, Private Gynecology and Obstetrics Clinic, Ankara, Türkiye
- Obstetrics and Gynecology, Canakkale State Hospital, Canakkale, Türkiye
- Gynecologic Oncology, Ankara City Hospital, Health Sciences, Ankara, Türkiye
- Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Türkiye
- Faculty of Medicine, Department Obstetrics and Gynecology, Ufuk University, Ankara, Türkiye
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Abstract
Introduction: Amniocentesis (AC) is the most used interventional procedure for prenatal diagnosis. The study aims to evaluate the pregnancy outcomes undergoing AC and the potential of amnion progesterone receptor (aPR) to alfa fetoprotein (AFP) rate for predicting the probability of neonatal intensive care unit (NICU). Material and methods: This prospective cross-sectional study population consisted of 85 pregnant women who underwent mid-trimester AC. All cases were screened by ultrasound before AC. Maternal venous and amniotic samples were obtained simultaneously to evaluate the serum progesterone (sPRG), aPR, and aAFP and analyzed with patient results. Results: Unlike sPRG and aAFP, aPR showed a positive correlation with NICU and a negative correlation with parity. In linear regression, the aPR-AFP rate showed strong linearity with NICU and parity. In an aPR-AFP rate analysis, we saw a strong predictivity for NICU compared to the other three parameters. It presented 73.4% specificity and 79% sensitivity at 0.0075 cut-off (AUC: 0.78; p = 0.003; 95% CI: 0.608–0.914). Conclusions: Evaluating the PR either alone or in a rational combination with AFP will provide physicians with valuable information about the advanced process of pregnancy and postpartum complications. The physicians might use the aPR-AFP rate to predict NICU potential for pregnancy and need further studies to make more vital predictions on postpartum complications.
Abstract
Introduction: Amniocentesis (AC) is the most used interventional procedure for prenatal diagnosis. The study aims to evaluate the pregnancy outcomes undergoing AC and the potential of amnion progesterone receptor (aPR) to alfa fetoprotein (AFP) rate for predicting the probability of neonatal intensive care unit (NICU). Material and methods: This prospective cross-sectional study population consisted of 85 pregnant women who underwent mid-trimester AC. All cases were screened by ultrasound before AC. Maternal venous and amniotic samples were obtained simultaneously to evaluate the serum progesterone (sPRG), aPR, and aAFP and analyzed with patient results. Results: Unlike sPRG and aAFP, aPR showed a positive correlation with NICU and a negative correlation with parity. In linear regression, the aPR-AFP rate showed strong linearity with NICU and parity. In an aPR-AFP rate analysis, we saw a strong predictivity for NICU compared to the other three parameters. It presented 73.4% specificity and 79% sensitivity at 0.0075 cut-off (AUC: 0.78; p = 0.003; 95% CI: 0.608–0.914). Conclusions: Evaluating the PR either alone or in a rational combination with AFP will provide physicians with valuable information about the advanced process of pregnancy and postpartum complications. The physicians might use the aPR-AFP rate to predict NICU potential for pregnancy and need further studies to make more vital predictions on postpartum complications.
Keywords
amnion progesterone receptor; alfa fetoprotein; neonatal; intensive care
About this articleTitle
A novel prenatal index predicting the probability of neonatal intensive care in pregnants: amnion progesterone receptor to alfa fetoprotein rate
Journal
Issue
Article type
Research paper
Pages
727-732
Published online
2023-05-04
Page views
350
Article views/downloads
287
DOI
Pubmed
Bibliographic record
Ginekol Pol 2023;94(9):727-732.
Keywords
amnion progesterone receptor
alfa fetoprotein
neonatal
intensive care
Authors
Seyma Banu Arslanca
Tolga Ecemis
Ozgur Sahin
Sevgi Ayhan
Tufan Arslanca
Gamze Sinem Yucel
References (23)- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 88, December 2007. Invasive prenatal testing for aneuploidy. Obstet Gynecol. 2007; 110(6): 1459–1467.
- Alfirevic Z, Navaratnam K, Mujezinovic F. Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database Syst Rev. 2017; 9(9): CD003252.
- Jummaat F, Ahmad S, Mohamed Ismail NA. 5-Year review on amniocentesis and its maternal fetal complications. Horm Mol Biol Clin Investig. 2019; 40(2).
- Nizard J. Amniocentesis: technique and education. Curr Opin Obstet Gynecol. 2010; 22(2): 152–154.
- Simpson JL, Rechitsky S. Preimplantation diagnosis and other modern methods for prenatal diagnosis. J Steroid Biochem Mol Biol. 2017; 165(Pt A): 124–130.
- Czyzyk A, Podfigurna A, Genazzani AR, et al. The role of progesterone therapy in early pregnancy: from physiological role to therapeutic utility. Gynecol Endocrinol. 2017; 33(6): 421–424.
- Di Renzo GC, Giardina I, Clerici G, et al. Progesterone in normal and pathological pregnancy. Horm Mol Biol Clin Investig. 2016; 27(1): 35–48.
- Weiss G. Endocrinology of parturition. J Clin Endocrinol Metab. 2000; 85(12): 4421–4425.
- Garg D, Ng SS, Baig KM, et al. Progesterone-Mediated Non-Classical Signaling. Trends Endocrinol Metab. 2017; 28(9): 656–668.
- Zakar T, Hertelendy F. Progesterone withdrawal: key to parturition. Am J Obstet Gynecol. 2007; 196(4): 289–296.
- Nadeem L, Shynlova O, Matysiak-Zablocki E, et al. Molecular evidence of functional progesterone withdrawal in human myometrium. Nat Commun. 2016; 7: 11565.
- Wu SP, DeMayo FJ. Progesterone Receptor Signaling in Uterine Myometrial Physiology and Preterm Birth. Curr Top Dev Biol. 2017; 125: 171–190.
- Merlino A, Welsh T, Erdonmez T, et al. Nuclear progesterone receptor expression in the human fetal membranes and decidua at term before and after labor. Reprod Sci. 2009; 16(4): 357–363.
- Smith R, Mesiano S, McGrath S. Hormone trajectories leading to human birth. Regul Pept. 2002; 108(2-3): 159–164.
- Tenore JL. Methods for cervical ripening and induction of labor. Am Fam Physician. 2003; 67(10): 2123–2128.
- Astle S, Slater DM, Thornton S. The involvement of progesterone in the onset of human labour. Eur J Obstet Gynecol Reprod Biol. 2003; 108(2): 177–181.
- Klebanoff MA, Meis PJ, Dombrowski MP, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med. 2003; 348(24): 2379–2385.
- Fahlbusch FB, Heussner K, Schmid M, et al. Measurement of amniotic fluid steroids of midgestation via LC-MS/MS. J Steroid Biochem Mol Biol. 2015; 152: 155–160.
- Mazor M, Hershkowitz R, Ghezzi F, et al. Maternal plasma and amniotic fluid 17 beta-estradiol, progesterone and cortisol concentrations in women with successfully and unsuccessfully treated preterm labor. Arch Gynecol Obstet. 1996; 258(2): 89–96.
- Nagamani M, McDonough PG, Ellegood JO, et al. Maternal and amniotic fluid steroids throughout human pregnancy. Am J Obstet Gynecol. 1979; 134(6): 674–680.
- Norwitz ER, Caughey AB. Progesterone supplementation and the prevention of preterm birth. Rev Obstet Gynecol. 2011; 4(2): 60–72.
- Oh SY, Kim CJ, Park I, et al. Progesterone receptor isoform (A/B) ratio of human fetal membranes increases during term parturition. Am J Obstet Gynecol. 2005; 193(3 Pt 2): 1156–1160.
- Leonhardt SA, Boonyaratanakornkit V, Edwards DP. Progesterone receptor transcription and non-transcription signaling mechanisms. Steroids. 2003; 68(10-13): 761–770.
