Iffat Rahman¹, Tripti Rani Das², Sabiha Islam³, Bidisha Chakma³, Jinat Fatema⁵, Shah Noor Sharmin⁴, Farah Noor⁵ and Tanzina Iveen Chowdhury⁵*

¹Medical Officer, Department of Obstetrics and Gynecology, Aliahat Hospital, Bogra, Bangladesh
²Professor, Department of Obstetrics and Gynecology, Bangladesh Medical University (BMU), Dhaka, Bangladesh
³Associate Professor, Department of Obstetrics and Gynecology, BMU, Dhaka, Bangladesh
⁴Medical officer, Department of Obstetrics and Gynecology, BMU, Dhaka, Bangladesh ⁵Assistant Professor, Department of Obstetrics and Gynecology, BMU, Dhaka, Bangladesh.

*Corresponding Author: Tanzina Iveen Chowdhury, Assistant Professor, Department of Obstetrics and Gynecology, Bangladesh Medical University, Dhaka, Bangladesh.

Received: May 23, 2025; Published: June 16, 2025

Abstract

Background: Preterm labor remains a principal cause of neonatal morbidity and mortality globally, with mostly high incidence in low- and middle-income countries like Bangladesh and across the Indian subcontinent. Despite worldwide efforts, early identification of preterm labor remains a challenge, highlighting the necessity for consistent, reachable biomarkers to recover maternal and neonatal outcomes in these areas.

Aim: To establish the comparison between maternal serum ferritin and C-reactive protein (CRP) levels in preterm labor.

Methods: A case-control study was conducted at the Department of Obstetrics and Gynecology, Bangladesh Medical University, from June 2022 to May 2023. A total of 130 pregnant women in labor (65 preterm, 65 full term) were registered using non-probability sampling technique. Serum ferritin and CRP levels were measured using Microparticle Enzyme Immunoassay (MEIA) and Particle Enhanced Turbidimetric Immunoassay (PETIA), methods, correspondingly. Data were analyzed with SPSS v26, p < 0.05 measured statistically significant. Ethical approval and informed consent were obtained.

Results: Maternal serum ferritin levels were significantly lower in preterm cases compared to full-term controls (mean ± SD: 1.98 ± 0.12 vs. 2.00 ± 0.00 ng/ml, p = 0.044). ROC curve analysis for ferritin at a cutoff ≤26 ng/ml presented a sensitivity of 60.1%, specificity of 84.6%, and overall accuracy of 90.0%. In contrast, CRP levels were significantly raised in the preterm group, with 81.5% display increased CRP compared to none in the full-term group (p < 0.001). ROC curve for CRP shown excellent power, confirming its higher predictive value for preterm labor.

Conclusion: CRP displayed significantly developed diagnostic correctness than serum ferritin in finding preterm labor. Its strong sensitivity and specificity support its potential as a valuable early marker in clinical assessment. Incorporating CRP testing may advance early detection and managing of preterm labor risk.

 Keywords: Preterm Labor; C-Reactive Protein; Serum Ferritin; Biomarkers; Maternal Health

References

1. Saifon Chawanpaiboon., et al. “Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis, Chawanpaiboon, Saifon”. The Lancet Global Health1 (2014): e37-e46.
2. Purisch SE and Gyamfi-Bannerman C. “Epidemiology of preterm birth”. Seminars in Perinatology 7 (2017): 387-391.
3. Vogel JP., et al. “The global epidemiology of preterm birth”. Best Practice and Research Clinical Obstetrics and Gynaecology 52 (2018): 3-12.
4. Granese R., et al. ”Preterm birth: seven-year retrospective study in a single centre population”. Italian Journal of Pediatrics 45 (2019): 1-6.
5. Goldenberg RL., et al. “Epidemiology and causes of preterm birth”. Lancet 371.9606 (2008): 75-84.
6. Shalal MM and Ibrahim BN. “Assessment of Preventive Foot Care Practices among Patients with Diabetes Mellitus Type II”. Journal of the Faculty of Medicine Baghdad 4 (2024).
7. Brown RG., et al. “Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes”. Translational Research 207 (2019): 30-43.
8. Tita AT, Andrews WW. “Diagnosis and Management of Clinical Chorioamnionitis”. Clinics in Perinatology 2 (2010): 339-354.
9. Stepan M., et al. “Maternal Serum C-Reactive Protein in Women with Preterm Prelabor Rupture of Membranes”. PLoS One 3 (2016): e0150217.
10. Sen C., et al. “The importance of C-reactive protein and procalcitonin in the diagnosis of chorioamnionitis in the cases with preterm premature rupture of membranes”. Perinatal Journal3 (2020): 190-195.
11. Martinez RT., et al. “Use of C-reactive protein as a predictor of chorioamnionitis in preterm prelabour rupture of membranes: a systematic review”. BJOG7 (2007): 796-801.
12. Meisner M. ”Update on Procalcitonin Measurements”. Annals of Laboratory Medicine 4 (2014): 263-273.
13. Valappil SA., et al. “Serum Ferritin as A Marker for Preterm Premature Rupture of Membranes -A Study From A Tertiary Centre in Central Kerala”. Journal of Clinical and Diagnostic Research 7 (2015): QC09-QC12.
14. Omar K., et al. “Parity 31 (2019):29-31.
15. Khattab M., et al. “The Egyptian Journal of Hospital Medicine2 (2018): 202-206.
16. Torbé A and Kowalski K. “Maternal serum and vaginal fluid C-reactive protein levels do not predict early-onset neonatal infection in preterm premature rupture of membranes”. Journal of Perinatology10 (2010): 655-659.
17. Thornburg LL., et al. “Procalcitonin for prediction of chorioamnionitis in preterm premature rupture of membranes”. The Journal of Maternal-Fetal and Neonatal Medicine 13 (2016): 2056-2061.
18. Wiwanitkit V. “Maternal C-Reactive Protein for Detection of Chorioamnionitis: an Appraisal”. Infectious Diseases in Obstetrics Gynecology3 (2005): 213-215.
19. Ronzino-Dubost V., et al. “[Evaluation of the interest of procalcitonin in the diagnosis of chorioamnionitis in preterm premature rupture of membranes. An observational and prospective study]”. Journal of Gynecology Obstetrics and Human Reproduction (Paris) 7 (2016): 745-753.
20. Bakar RZ., et al. “Maternal serum procalcitonin levels in prediction of chorioamnionitis in women with preterm premature rupture of membranes”. Archives of Medical Science3 (2021): 694-699.
21. Friedman A., et al. “Simultaneous removal of antibiotic-resistant Escherichia coliand its resistance genes by dielectric barrier discharge plasma”. Environmental Research 233 (2023): 116163.

Citation

Citation: Tanzina Iveen Chowdhury., et al. “Comparison of Maternal Serum Ferritin and C-reactive protein Levels in the Diagnosis of Preterm Labor”.Acta Scientific Medical Sciences 9.7 (2025): 62-67.

Copyright

Copyright: © 2025 Tanzina Iveen Chowdhury., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.