The study is devoted to identifying risk factors for spontaneous preterm birth (sPTB) based on the investigation of pathogenetic relationships between clinical and anamnestic characteristics, melatonin and magnesium levels, inflammatory markers, ultrasound parameters of the cervix, sleep quality disturbances, and anxiety levels.
To achieve the aim of the study, 87 women were included. The main study group consisted of 57 women aged 16 to 43 years (mean age - 30.9 (7.2) years), whose pregnancies ended in sPTB at 24–36 weeks of gestation (median 34 [31; 35] weeks). The control group included 30 pregnant women aged 18 to 41 years (mean age 30.8 (5.7) years) who delivered at term (median 39 [39; 40] weeks).
The criteria for inclusion in the study were the presence of risk factors for sPTB at 24+0 to 36+6 weeks of gestation in singleton pregnancies, absence of indications for medically indicated preterm cesarean delivery, and signed informed consent of the patient to participate in the study.
Scientific novelty. Our understanding of clinical and anamnestic factors as potential predictors of sPTB between 24+0 and 36+6 weeks’ gestation has been expanded, particularly with regard to complicated pregnancies involving threatened miscarriage in the first and second trimesters and anaemia in the second trimester.
Haematological and biochemical studies conducted during pregnancy have confirmed the key role of systemic inflammation, as well as abnormalities in platelet and red blood cell function, in the pathogenesis of sPTB.
Scientific data have been supplemented regarding reduced magnesium levels and magnesium deficiency in pregnant women at risk of sPTB, which reflect disturbances in metabolic regulation and contribute to increased neuromuscular excitability and a potential tendency to premature activation of uterine contractions.
It has been established for the first time that reduced levels of melatonin in saliva at night, measured on the day of delivery, can be used as an independent prognostic marker of high risk of sPTB in early gestation.
The significant role of sleep disorders as a risk factor for sPTB has been demonstrated. For the first time, substantial correlations between the components of sleep quality prior to delivery and indicators of reactive and state anxiety in women with sPTB have been established.
Predictive characteristics of risk factors for sPTB have been identified based on clinical and anamnestic data, laboratory markers in blood and saliva, sonographic measurements of cervical status, and indicators of dyssomnia and elevated anxiety.
Theoretical and practical value of the study. This study clarifies and systematises current understanding of the relationship between laboratory markers of inflammation (leucocytosis, an increased neutrophil-to-lymphocyte ratio, erythrocyte sedimentation rate and C-reactive protein) and the risk of sPTB. To identify the high-risk group for sPTB between 24+0 and 36+6 weeks’ gestation, it is recommended to measure the level of melatonin in the saliva of pregnant women.
Furthermore, the significance of ultrasonographic anatomical and functional parameters of the cervix (cervical length, uterocervical angle and their ratio) as predictors of sPTB has been substantiated. A recommendation has been proposed and implemented in clinical practice to expand the scope of ultrasound screening in the second trimester of pregnancy (at 18–22 weeks), involving the measurement of the uterocervical angle (UCA) during cervicometry and the calculation of the UCA/cervical length ratio as a predictor of sPTB.
For the first time, the value of integrating psycho-emotional factors – in particular, sleep quality disturbances and elevated anxiety levels – into a unified concept of a multifactorial, risk-oriented approach to predicting sPTB has been emphasised. The rationale for incorporating psychometric tools (the Pittsburgh Sleep Quality Index and the Spielberger–Hanin Anxiety Scale) into the management of high-risk pregnant women has been established.
An algorithm has been developed for the step-by-step identification of pregnant women at high risk of sPTB, which included the assessment of clinical and anamnestic data, threshold values for ultrasound and laboratory markers, sleep disturbances and elevated anxiety levels, and the development of personalised recommendations during pregnancy to prevent sPTB. Practical approaches to correcting the identified disorders have been proposed, in particular non-pharmacological methods: sleep hygiene, positional therapy and psychotherapeutic methods with proven efficacy, especially in the second and third trimesters of pregnancy.
