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Elevated Mid-Trimester Amniotic Fluid ADAM-8 Concentrations as a Potential Risk Factor for Preterm Delivery

Second Department of Obstetrics and Gynecology, Aretaeion Hospital, University of Athens, and the Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens, Greece; Second Department of Obstetrics and Gynecology, 124B Vasilisis Sofias Ave, 115 26 Athens, Greece; nvrachnis{at}hotmail.com

Adriadne Malamitsi-Puchner, MD

Evi Samoli, PhD

Dimitrios Botsis, MD

Zoe Iliodromiti, MD

Stavroula Baka, MD

Dimitrios Hassiakos, MD

George Creatsas, MD

Second Department of Obstetrics and Gynecology, Aretaeion Hospital, University of Athens, and the Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens, Greece

Objective: To determine during mid-trimester amniocentesis if elevated concentrations of ADAM-8 (A Disintegrin And Metalloprotease 8) and/or cortisol can recognize women at risk for spontaneous preterm delivery.

Methods: The study involved 312 women who underwent mid-trimester amniocentesis. Thirteen patients, who progressed to preterm delivery, were matched with 21 controls for age, parity, gestational age at amniocentesis, and year of amniocentesis. ADAM-8 and cortisol levels were measured by enzyme-linked immunosorbent assay and radioimmunoassay, respectively.

Results: ADAM-8 mean amniotic fluid concentrations were significantly higher in women with preterm delivery than in women delivering at term (mean 1213.9 [SE 96.7] pg/mL [range, 780 to 1854 pg/mL] vs mean 937.2 [SE 50.3] pg/mL [range, 486 to 1508 pg/mL], P < .02). Amniotic fluid ADAM-8 concentrations higher than 1149 pg/mL had the highest specificity and odds ratio (OR) in the identification of the women with increased risk for preterm delivery (sensitivity 61.5%; specificity 81.7%; OR, 9.6 [95% confidence interval (CI), 1.8 to 50.3]). Women with preterm delivery had suggestively higher amniotic fluid concentrations of cortisol (mean 1.3 [SE 0.2] µg/dL [range, 0.4 to 2.2 µg/dL]) than women delivering at term (mean 1.0 [SE 0.09] µg/dL [range, 0.6 to 1.7 µg/dL], P < .07). Furthermore, cortisol levels were positively correlated with ADAM-8 levels (Spearman's r = .418, P < .014).

Conclusions: Elevated mid-trimester amniotic fluid ADAM-8 concentrations possibly are a risk factor for preterm delivery, particularly if ADAM-8 levels are greater than 1149 pg/mL. Potential intrauterine inflammation is also associated with suggestively increased amniotic fluid cortisol levels.

Key Words: Amniotic fluid • preterm labor • preterm rupture of membranes • inflammation • ADAM-8 • cortisol

Journal of the Society for Gynecologic Investigation, Vol. 13, No. 3, 186-190 (2006)
DOI: 10.1016/j.jsgi.2006.01.003


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