Dysregulated biomarkers induce distinct pathways in preterm birth

Objective To document racial disparity in biomarker concentrations in maternal/fetal plasma and amniotic fluid between African Americans and European Americans with spontaneous preterm birth (PTB; cases) and normal term birth (controls), and their contribution to distinct pathophysiological pathways of PTB. Design Nested case-control study. Setting The Perinatal Research Center, Nashville, Tennessee, USA. Sample Maternal and fetal plasma and amniotic fluid samples were collected from 105 cases (59 African American and 46 European American) and 86 controls (40 African American and 46 European American). Methods Thirty-six biomarkers were analysed using the protein microarray approach. Main outcome measures Differences in biomarker concentrations between cases and controls of different races in maternal, fetal and intra-amniotic compartments, and the risk of PTB. Dysregulated biomarker-induced PTB pathways associated with PTB in each race were determined using ingenuity pathway analysis (IPA). Results Racial disparity was observed in biomarker concentrations in each compartment between cases and controls: amniotic fluid, IL8 and MIP1a differed between case and controls in European Americans, whereas ANGPT2, Eotaxin, ICAM-1, IL-1b, IL1RA, RANTES and TNFa differed between case and controls in African Americans. In both races the FAS ligand, MCP-3 and TNFR-1 differed between cases and controls. For fetal plasma, ANGPT2, Eotaxin, FGF basic, ICAM-1, IGF-I, IL10, IL-1b, IL2, IP10 KGF, MCP-3, MIP1a, PDGF-BB, TGFa, TGFb1, TIMP1, TNFa, TNFR-I, TNFR-II and VEGF differed between cases and controls in European Americans, whereas only MMP7 differed between cases and controls in African Americans. IL-8 differed between cases and controls in both races. For maternal plasma, IL1RA, MMP7 and VEGF differed between cases and controls in European Americans, whereas ANGPT2, FGF basic, IL-1b, IL5, IL6R, KGF, MCP-3, MIP1a, TIMP1 and TNFa differed between cases and controls in African Americans. ANG, IL8 and TNFR-I differed between cases and controls in both races. Conclusions We conclude that: ( 1) biomarker concentrations in maternal, fetal and intra-amniotic compartments differ between cases and controls; ( 2) there is racial disparity in the biomarker profile in each of the compartments; ( 3) substantial numbers of dysregulated fetal plasma biomarkers contribute to PTB in European Americans, whereas maternal plasma biomarkers contribute to PTB in African Americans; and ( 4) both inflammation and haematological functions are associated with PTB in European Americans, but maternal proinflammatory changes dominate PTB in African Americans. Biomarker analyses document racial disparity and the distinct pathophysiological contributions from different compartments that can determine pregnancy outcome.