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Manuck, Tracy A.; Esplin, M. Sean; Biggio, Joseph R., Jr.; Bukowski, Radek K.; Parry, Samuel; Zhang, Heping; Huang, Hao; Varner, Michael W.; Andrews, William W.; & Saade, George R., et al. (2015). The Phenotype of Spontaneous Preterm Birth: Application of a Clinical Phenotyping Tool. American Journal of Obstetrics & Gynecology, 212(4), 487e1-11. PMCID: PMC4456184


OBJECTIVE: Spontaneous preterm birth (SPTB) is a complex condition that is likely a final common pathway with multiple possible causes. We hypothesized that a comprehensive classification system appropriately could group women with similar STPB causes and could provide an explanation, at least in part, for the disparities in SPTB that are associated with race and gestational age at delivery.
STUDY DESIGN: This was a planned analysis of a multicenter, prospective study of singleton SPTBs. Women with SPTB at <34 weeks' gestation were included. We defined 9 potential SPTB phenotypes based on clinical data: infection/inflammation, maternal stress, decidual hemorrhage, uterine distention, cervical insufficiency, placental dysfunction, premature rupture of the membranes, maternal comorbidities, and familial factors. Each woman's condition was evaluated for each phenotype. Delivery gestational age was compared between those with and without each phenotype. Phenotype profiles were also compared between women with very early (20.0-27.9 weeks' gestation) SPTB vs those with early SPTB (28.0-34.0 weeks' gestation) and between African American and white women. Statistical analysis was by t test and chi(2) test, as appropriate.
RESULTS: The phenotyping tool was applied to 1025 women with SPTBs who delivered at a mean 30.0 +/- 3.2 (SD) weeks' gestation. Of these, 800 women (78%) had >/=2 phenotypes. Only 43 women (4.2%) had no phenotypes. The 281 women with early SPTBs were more likely to have infection/ inflammation, decidual hemorrhage, and cervical insufficiency phenotypes (all P CONCLUSION: Precise SPTB phenotyping classifies women with SPTBs and identifies specific differences between very early and early SPTB and between African American and white women.


Reference Type

Journal Article

Year Published


Journal Title

American Journal of Obstetrics & Gynecology


Manuck, Tracy A.
Esplin, M. Sean
Biggio, Joseph R., Jr.
Bukowski, Radek K.
Parry, Samuel
Zhang, Heping
Huang, Hao
Varner, Michael W.
Andrews, William W.
Saade, George R.
Sadovsky, Yoel
Reddy, Uma M.
Ilekis, John, for the
Eunice Kennedy Shriver
National Institute of Child Health and Human Development Genomics and Proteomics Network for Preterm Birth Research [
John M. Thorp, Jr., Member