Abstract
Preterm birth (PTB; <37 completed weeks of gestation), is one of the major clinical dilemmas of pregnancy. Understanding PTB has been difficult, as the risk factors and pathophysiological factors associated with PTB are poorly understood. Our current knowledge of risk factors and biomarkers in predicting the ‘high-risk’ status during pregnancy has not been successful in reducing the PTB rate, and it has continued to rise in the past few decades. Disparities in the PTB rates observed among different racial groups further complicate the understanding of PTB, suggesting that the risk factors and biomarkers are not universal, and that risk assessment should be made based on a multitude of factors associated with a given individual (personalized risk assessment). Genetic variations and their interactions with the environment can produce distinct risk profiles during pregnancy. In this review, complexities associated with spontaneous PTB are discussed and, to unravel these complexities, using race as a surrogate, current findings on genetic and biomarker differences and their interaction with the environment in determining pregnancy outcomes are discussed.
Acknowledgements
The author acknowledges Stephen J Fortunato, MD, Nicole Morgan, Cayce Owens and Susan Hannel (The Perinatal Research Center, Nashville, TN, USA); Scott M Williams, PhD (Vanderbilt University, Nashville, TN, USA); Poul Thorsen, MD, PhD, Brad Pearce, PhD, Anne Dunlop, MD, Carol Hogue, PhD, Robert N Taylor, MD, PhD, Stephanie Sherman, PhD, Claudine Carnevale (Preterm Birth Research International Center of Excellence [PRiCE], Emory University, Atlanta, GA, USA); and Digna R Velez, PhD (University of Miami, Miami, FL, USA) for their support of ongoing research projects.
Financial & competing interests disclosure
This review was made possible by Perinatal Research Initiative grant support by March of Dimes, USA, to Ramkumar Menon. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.