Predictive value of maternal serum occludin for neonatal respiratory distress syndrome in spontaneous preterm birth

Why clinicians should know about it

• Picked for Obstetrics and Gynecology (paper of the day, 23 September 2026): Maternal serum occludin predicts neonatal respiratory distress in preterm birth

Abstract

OBJECTIVE: This study investigates maternal serum occludin and human leukocyte antigen G (HLA-G) profiles across preterm birth subtypes and their predictive value for neonatal respiratory distress syndrome (NRDS). METHODS: This retrospective analysis was conducted at Tianjin Central Hospital of Gynecology Obstetrics in Tianjin, China. The study utilized a prospectively collected cohort of 133 singleton preterm births, including iatrogenic preterm birth (iPB, n = 22), spontaneous preterm labor with intact membranes (sPTL, n = 61), and preterm premature rupture of membranes (pPROM, n = 50). Maternal serum levels of occludin and HLA-G were measured via ELISA assays. Subtype-specific predictive performance for NRDS was assessed using receiver operating characteristic curve analysis based on logistic regression analysis. RESULTS: Maternal serum occludin concentrations exhibited distinct subtype-specific distributions: the highest levels in the iPB group, intermediate levels in the pPROM group, and lowest levels in the sPTL group (overall P < 0.001), which remained significant after adjusting for gestational age at delivery. HLA-G levels were markedly lower in the pPROM and sPTL groups compared to the iPB group (P < 0.01). Notably, within the sPTL cohort, pregnancies complicated by NRDS exhibited not only a reduced gestational age (P < 0.001) but also a paradoxical elevation in maternal occludin levels (P = 0.019). A combined model incorporating occludin and gestational age at delivery demonstrated excellent discriminatory power for predicting NRDS specifically within the sPTL subtype (area under the curve = 0.829, 95% confidence interval: 0.714-0.943). CONCLUSION: Preterm birth subtypes manifest substantial pathophysiological heterogeneity along the "barrier-immune" axis. Specifically in sPTL, the combination of maternal occludin levels with gestational age might serve as a potential noninvasive adjunctive biomarker for NRDS risk stratification, although its predictive value requires further validation in larger prospective cohorts.

Abstract as published, via PubMed.