Serum ferritin: a predictor of early spontaneous preterm delivery

OBJECTIVE: To identify biochemical indices for iron and protein nutriture as well as acute-phase reactants as predictors of preterm delivery. METHODS: In this nested case-control study, serum samples were obtained at about 24 weeks' gestation from 94 indigent multiparas. These cases were defined based on having a spontaneous delivery of 32 weeks or less (n = 31) with two control groups, one delivering spontaneously at 33-36 weeks (n = 32) and the other delivering spontaneously at 37 weeks or more (n = 31). The concentrations of iron, ferritin, transferrin, transferrin saturation, and transferrin receptor were measured as indices of iron status. The concentrations of acute-phase reactants, including C-reactive protein, alpha-2-macroglobulin, beta-2-microglobulin and ceruloplasmin, were also measured, along with albumin, prealbumin, retinol-binding protein, copper, and zinc. RESULTS: Serum ferritin concentrations were negatively correlated with gestational age at birth (P = .034). For subjects having serum ferritin levels above the median compared with those below, the odds ratio of having an early spontaneous preterm delivery was 2.99 (95% confidence interval 1.13-7.89). The other indices, including iron status and the acute-phase reactants, were not significantly associated with gestational age at birth. CONCLUSION: Elevated serum ferritin levels during the second trimester are predictive of early spontaneous preterm delivery, possibly because these reflect an acute-phase reaction to subclinical infections that are closely associated with premature delivery.

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