Insulin-like growth factor binding protein-1 predicts preterm premature rupture of membranes in twin pregnancies

  • Giovanni SistiEmail author
  • Sara Paccosi
  • Astrid Parenti
  • Viola Seravalli
  • Mariarosaria Di Tommaso
  • Steven S. Witkin
Maternal-Fetal Medicine



Mechanisms leading to preterm premature rupture of membranes (PPROM) remain incompletely defined. Based on the elevated occurrence of PPROM in twin gestations and recent studies of the involvement of insulin-like growth factor binding protein-1 (IGFBP-1) in the inhibition of collagen production we hypothesized that serum IGFBP-1 levels might be predictive of susceptibility to PPROM in women with twins.


In this prospective study peripheral blood was obtained from 58 women with twin gestations prior to 20 weeks gestation and sera analyzed by ELISA for concentrations of IGFBP-1. Demographic and clinical outcome data were subsequently obtained and associations between IGFBP-1 and PPROM were analyzed by the Mann–Whitney test and receiver operator curve (ROC) analysis.


Eight of our subjects developed PPROM. They did not differ from the other women in demographics, medical history or current pregnancy outcome parameters. However, median IGFBP-1 levels were higher in women who subsequently developed PPROM (59.3 ng/ml) than in the other women (46.6 ng/ml) (p = 0.042). Using a cutoff value of 53.9 ng/ml the circulating IGFBP-1 level predicted development of PPROM with a sensitivity of 74%, specificity of 75%, a negative predictive value of 97% and a positive predictive value of 20%.


Pending validation in larger studies the findings suggest that determination of serum IGFBP-1 levels in women with twin pregnancies may predict the later development of PPROM.


Insulin-like growth factor binding protein Preterm premature rupture of membranes Twins Sera 


Author contributions

GS: project development, data collection, and manuscript writing. SP: samples management, data analysis. AP: data collection. VS: manuscript writing. MDT: project development, and manuscript writing. SW: data analysis, and manuscript writing.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyLincoln Medical and Mental Health CenterBronxUSA
  2. 2.Department of Obstetrics and GynecologyWeill Cornell MedicineNew YorkUSA
  3. 3.Department of Health SciencesUniversity of FlorenceFlorenceItaly
  4. 4.Department of Health Sciences, Obstetrics and Gynecology BranchUniversity of FlorenceFlorenceItaly

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