Document Detail


Fetal fibronectin and adverse infant outcomes in a predominantly human immunodeficiency virus-infected African population: a randomized controlled trial.
MedLine Citation:
PMID:  17267841     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the relationship between fetal fibronectin and preterm birth and maternal-to-child transmission of human immunodeficiency virus (HIV) in an African population of predominantly HIV-infected women. METHODS: During a trial of second trimester and intrapartum antibiotics compared with placebo to prevent chorioamnionitis and reduce preterm birth and mother-to-child transmission of HIV, vaginal fluid was collected before antibiotics (20-24 weeks) and after treatment at 28 weeks and assayed for fetal fibronectin. Pregnancy outcomes of 2,353 women delivering liveborn singleton infants are presented. RESULTS: Positive fetal fibronectin assays (50 ng/mL or more) were detected in 4.2% and 4.9% of samples at 20-24 weeks and 28 weeks. Positive fetal fibronectin assays at 28 weeks but not at 20-24 weeks were associated with lower mean birthweight (199 g, P<.001); lower mean gestational age (2 weeks, P<.001); six-fold higher rate of preterm birth less than 32 weeks (10.8% compared with 1.9%, odds ratio 6.3, 95% confidence interval 3.2-12.3) and a two-fold higher rate of preterm birth less than 37 weeks (38.7 compared with 22.0%, odds ratio 2.3, 95% confidence interval 1.5-3.3). Also, at 28 weeks, as the fetal fibronectin values increased, each of the outcomes worsened, and every test of trend was significant. An association between elevated fetal fibronectin levels and mother-to-child transmission of HIV was present at 20 to 24 weeks but not at 28 weeks. Antibiotic treatment at 20 to 24 weeks was not associated with fetal fibronectin levels at 28 weeks. CONCLUSION: In a population of predominantly HIV- infected African women, fetal fibronectin concentrations at 28 but not at 20-24 weeks were associated with increased risk of preterm birth. The associations were stronger for early preterm birth and when fetal fibronectin levels were higher. High levels of fetal fibronectin were positively associated with mother-to-child transmission of HIV at 20 -24 but not at 28 weeks. Antibiotic treatment did not influence fetal fibronectin levels. CLINICAL TRIAL REGISTRATION: www.clinicalTrials.gov, NCT00021671 LEVEL OF EVIDENCE: I.
Authors:
Robert L Goldenberg; William W Andrews; Irving Hoffman; Wafai Fawzi; Megan Valentine; Alicia Young; Jennifer S Read; Elizabeth R Brown; Victor Mudenda; George Kafulafula; Kasonde Mwinga; Taha E Taha
Publication Detail:
Type:  Clinical Trial, Phase III; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  109     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-01     Completed Date:  2007-02-27     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  392-401     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1500 6th Avenue South, Birmingham, AL 35233, USA. rlg@uab.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00021671
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MeSH Terms
Descriptor/Qualifier:
Adult
Africa South of the Sahara
African Continental Ancestry Group*
Anti-Bacterial Agents / therapeutic use
Female
Fetal Proteins / metabolism*
Fibronectins / metabolism*
HIV Infections / ethnology,  metabolism*,  transmission
Humans
Infectious Disease Transmission, Vertical / prevention & control
Placenta / pathology
Pregnancy
Pregnancy Complications, Infectious / ethnology,  metabolism*
Premature Birth / ethnology,  metabolism*,  prevention & control
Vagina / metabolism
Grant Support
ID/Acronym/Agency:
N01 AI 35173/AI/NIAID NIH HHS; N01 AI 35173-117/412/AI/NIAID NIH HHS; N01 AI 45200/AI/NIAID NIH HHS; U01 AI 048006/AI/NIAID NIH HHS; U01 AI 47972/AI/NIAID NIH HHS; U01 AI 48005/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Fetal Proteins; 0/Fibronectins
Comments/Corrections
Erratum In:
Obstet Gynecol. 2007 Oct;110(4):936

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