The Predictive Role of Maternal Serum Amyloid A in Preterm Birth: An Observational Study in Romania.

Background: Despite improvements in pregnancy care, preterm birth remains a major cause of neonatal morbidity and mortality worldwide, particularly in developing countries. Maternal inflammation has been recognized as a factor that may induce preterm birth, with various inflammatory markers associated with its pathogenesis. The aim of this study is to evaluate the value of maternal serum amyloid A(SAA) level as a predictive marker for preterm delivery in a Romanian cohort.

Methods: This observational study was carried out at a Romanian tertiary care hospital between April 2023 and March 2024. We enrolled 136 pregnant women and divided them into two groups depending on the beginning of labor: preterm (before 37 weeks, n=70) and term (after 37 weeks, n=66). Maternal blood samples were taken upon admission and analyzed using the Atellica® NEPH 630 System (Siemens Healthineers, Erlangen, Germany) to determine SAA levels. The best cut-off value for SAA was determined using receiver operating characteristic (ROC) curve analysis with the Youden index. Logistic regression models were then applied to assess the association between elevated SAA levels and preterm birth, adjusting for potential confounders such as maternal age and history of preterm birth.

Results: The median SAA levels were significantly higher in the preterm group (22 mg/L) compared to the term group (7 mg/L) (p<0.001). The ROC curve analysis yielded a moderate predictive value of SAA for preterm birth, with the area under the ROC curve (AUC) being 0.690. The threshold at 15 mg/L was the best cut-off value, achieving a sensitivity of 89% and a specificity of 85%. Elevated SAA levels were associated with a 27.89-fold increased risk of preterm delivery. Further, after adjusting for maternal age, medical conditions during pregnancy, and prior preterm birth, elevated SAA remained a significant predictor of preterm birth (adjusted odds ratio (aOR)=28.966; p=0.001).

Conclusion: Maternal SAA proved to be a strong independent risk factor for preterm birth. This biomarker further narrows the population of pregnant women at higher risk of preterm delivery and opens new perspectives for its clinical role in preterm birth prevention.