A treatment for premature delivery could be on the horizon, following a discovery by Yale scientists.
University researchers Dr. Irina Buhimschi and Dr. Catalin Buhimschi, along with researchers at the University of Maryland and Ciphergen Biosytems, have identified four proteins that are associated with premature delivery. The report, published in the February issue of the British Journal of Obstetrics and Gynecology, is the result of a five-year study funded by the National Institutes of Health and Ciphergen Biosystems.
According to the American Academy of Family Physicians, preterm delivery affects 8 to 10 percent of births in America each year. In some cases, preterm delivery can lead to complications that impair a child’s development, such as lung disease, cerebral palsy and physical or mental deficits.
The study employed magnetic resonance scoring, an experimental method to discriminate between healthy women and those who delivered preterm. Using amniotic fluid samples, the researchers sought to contrast the protein profiles of women who carried their babies to term with those who had severe preterm delivery problems. The samples were scored with an algorithm, which proved to be 100 percent accurate within the test population.
Irina Buhimschi said that not just the results but the method was important, since the validity of magnetic resonance scoring is independent of this particular test.
“The novelty of this method is that it can be applied to any paradigm,” she said. “You can take it and perform it anywhere you want.”
The researchers are now using their discovery to develop an effective diagnostic tool for preterm delivery, Irina Buhimschi said. Currently, the condition is diagnosed through observation of symptoms as well as three different clinical tests. These tests often contradict each other, leading to a high rate of false positives and confusion for physicians who must decide how to address the problem. Dr. Carl Weiner, a researcher at the University of Maryland, said a diagnostic test using the combination of proteins identified by the study could potentially be faster, less invasive and more accurate than current methods.
Beyond the immediate diagnostic implications, Weiner said the discovery of protein biomarkers could revolutionize obstetrics if it leads to an understanding of the underlying cause of premature birth. Although inflammation or infection in the uterus is typically found in women who deliver prematurely, there is no known cause or treatment.
“Understanding the cause is the first step, and that’s why we’ve done so poorly with preterm birth,” Weiner said. “We haven’t understood clearly what the causes were, and so our efforts were just shotguns.”
Irina Buhimschi said further studies are underway, and researchers hope to eventually develop a treatment or even cure for preterm delivery. Few treatment options exist today for women facing the complication, she said, and choosing which to use is not always easy. Doctors can choose either to induce birth or to delay it for up to 48 hours with drugs that inhibit muscle contractions. But different cases call for different actions, and unresolved safety issues with the inhibitory drugs lead some doctors not to use them at all.
A more complete understanding of preterm delivery could potentially eliminate the ambiguity physicians must contend with when prescribing the right course of action for each individual mother, Irina Buhimschi said.
“Right now it’s a very subjective decision, and very often the decision that is made is not probably the best,” she said.
The researchers have also published a clinical application of their work and plan to present another application, which deals with cervical incompetence, this month at the annual meeting of the Society for Maternal Fetal Medicine.