Vol. 7, Issue 2, Part A (2025)

Background: Spontaneous preterm birth (SPTB), defined as delivery before 37 completed weeks of gestation without medical intervention, remains a leading cause of neonatal morbidity and mortality worldwide. Identifying reliable biomarkers that reflect inflammatory processes contributing to preterm labor may aid in early prediction and intervention. Alpha-1 antitrypsin (AAT), a multifunctional acute-phase protein with anti-inflammatory and immunomodulatory roles, has been proposed as a potential biomarker in this context.
Objective: To evaluate maternal serum alpha-1 antitrypsin (AAT) levels in pregnancies resulting in spontaneous preterm birth compared to term deliveries and to assess its predictive value as an inflammatory biomarker.
Methods: This observational cross-sectional study was conducted at Tikrit Teaching Hospital from October 1, 2024, to July 15, 2025. A total of 120 pregnant women were enrolled and categorized into two groups: SPTB (N=60) and term (N=60). Maternal serum AAT and C-reactive protein (CRP) levels were measured using chemiluminometric and immunonephelometric methods. Statistical analysis included independent t-tests, logistic regression, and ROC curve analysis using SPSS version 26.
Results: Mean maternal serum AAT levels were significantly higher in the SPTB group compared to the term group (1.95±0.35 vs. 1.65±0.28 g/L, P=0.003). Logistic regression revealed AAT as a significant independent predictor of SPTB (adjusted OR=2.29, 95% CI: 1.30-4.01, P=0.004). ROC analysis demonstrated good diagnostic performance for AAT (AUC=0.82), with optimal sensitivity (78.3%) and specificity (81.7%) at a cut-off value of 1.78 g/L. CRP levels were also elevated in the SPTB group but did not independently predict SPTB in adjusted models. Higher AAT and CRP levels were significantly associated with neonatal intensive care unit (NICU) admission among preterm neonates.
Conclusion: Elevated maternal serum AAT levels are significantly associated with spontaneous preterm birth and adverse neonatal outcomes, supporting its potential utility as a non-invasive inflammatory biomarker. These findings warrant further prospective validation and mechanistic studies to explore AAT’s role in the pathogenesis and early prediction of preterm labor.