{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:05:13Z","timestamp":1791929113991,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T00:00:00Z","timestamp":1657238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004853","name":"Chinese University of Hong Kong","doi-asserted-by":"publisher","award":["start up grant"],"award-info":[{"award-number":["start up grant"]}],"id":[{"id":"10.13039\/501100004853","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010428","name":"Innovation and Technology Fund","doi-asserted-by":"publisher","award":["ITS\/252\/17FX"],"award-info":[{"award-number":["ITS\/252\/17FX"]}],"id":[{"id":"10.13039\/501100010428","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine whether first\u2010trimester biomarkers of placental function can be used to screen for spontaneous preterm birth (sPTB), and to develop prediction models using maternal factors, obstetric history and biomarkers of placental function at 11\u201313\u2009weeks for the calculation of patient\u2010specific risk for sPTB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective secondary analysis of data derived from a prospective cohort study on first\u2010trimester screening for pre\u2010eclampsia in singleton pregnancies attending for routine Down syndrome screening at 11\u2009+\u20090 to 13\u2009+\u20096\u2009weeks' gestation at a tertiary obstetric unit between December 2016 and September 2019. A split\u2010sample internal validation method was used to explore and develop prediction models for all sPTB at &lt;\u200937\u2009weeks and for PTB at &lt;\u200937\u2009weeks after preterm prelabor rupture of membranes (PPROM) using maternal risk factors, uterine artery Doppler indices, serum placental growth factor (PlGF), pregnancy\u2010associated plasma protein\u2010A (PAPP\u2010A) and <jats:italic>\u03b2<\/jats:italic>\u2010human chorionic gonadotropin (<jats:italic>\u03b2<\/jats:italic>\u2010hCG). Screening performance was assessed using receiver\u2010operating\u2010characteristics (ROC)\u2010curve analysis, with calculation of the areas under the ROC curves (AUCs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 9298 singleton pregnancies were included in this study. sPTB at &lt;\u200937\u2009weeks occurred in 362 (3.89%) cases, including 231 (2.48%) cases of PPROM. sPTB at &lt;\u200934\u2009weeks occurred in 87 (0.94%) cases, including 39 (0.42%) cases of PPROM. Identified maternal risk factors for sPTB at &lt;\u200937\u2009weeks included chronic hypertension, conception using <jats:italic>in\u2010vitro<\/jats:italic> fertilization and history of PTB. Maternal risk factors for PPROM at &lt;\u200937\u2009weeks included conception using <jats:italic>in\u2010vitro<\/jats:italic> fertilization and history of PTB. Median PlGF multiples of the median (MoM) and PAPP\u2010A MoM were significantly reduced in women with sPTB at &lt;\u200937\u2009weeks, as well as in those who had PPROM, compared to those who delivered at term. Screening by a combination of maternal risk factors, PAPP\u2010A and PlGF achieved better performance in predicting sPTB at &lt;\u200937\u2009weeks (AUC, 0.630 <jats:italic>vs<\/jats:italic> 0.555; detection rate (DR), 24.8% <jats:italic>vs<\/jats:italic> 16.6% at a false\u2010positive rate (FPR) of 10%; <jats:italic>P<\/jats:italic>\u2009\u2264\u20090.0001) and PPROM at &lt;\u200937\u2009weeks (AUC, 0.643 <jats:italic>vs<\/jats:italic> 0.558; DR, 28.1% <jats:italic>vs<\/jats:italic> 17.0% at a FPR of 10%; <jats:italic>P<\/jats:italic>\u2009\u2264\u20090.0001) than using maternal risk factors alone. Both models were successfully applied to the internal validation dataset, with AUCs of 0.628 and 0.650, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We demonstrated that low levels of maternal serum PAPP\u2010A and PlGF in the first trimester are associated with increased risks of sPTB and PPROM at &lt;\u200937\u2009weeks. However, further research is needed to identify additional biomarkers to improve the screening performance of the combined model that includes maternal risk factors, PAPP\u2010A and PlGF before clinical application. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.24917","type":"journal-article","created":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T10:38:58Z","timestamp":1650537538000},"page":"192-199","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Prediction of spontaneous preterm birth and preterm prelabor rupture of membranes using maternal factors, obstetric history and biomarkers of placental function at 11\u201313\u2009weeks"],"prefix":"10.1002","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8743-1652","authenticated-orcid":false,"given":"C. P. 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