To determine if pro and anti-inflammatory cytokine concentrations in the cervico-vaginal secretions through gestation are predictive of spontaneous preterm birth (SPTB) in women at increased risk of SPTB.
A prospective observational cohort study was conducted at Mount Sinai Hospital (Toronto, CA); women at increased risk of prematurity due to obstetrical history (n=56) underwent vaginal swabs at <16w, 18-22w, 28-32w and >32w gestational ages. Concomitantly, TVUS assessment of cervical length was recorded. Obstetrical outcome data was collected. Cytokine concentrations were measured by multiplex ELISA. Significance was set at p<0.05.
The mean gestation age at delivery for this cohort was 36.9 + 5.0w (21-41w); the rate of SPTB < 37w was 27%. There was no significant change in the concentrations of IL-1beta;, GM-CSF, TNFalpha and IL-10 through gestation for all patients. There was a significant increase in IL-6 and IL-8 concentration from the initial (<16w) to the final assessment prior to delivery in patients who delivered both at term and preterm; for patients delivering at term the concentration of IL-6 and IL-8 did not increase until after 32w gestation. There was a significant decrease in IL-4 concentration prior to delivery patients who delivered at term but a significant increase prior to delivery in patients delivering preterm. There was no correlation between cervical length and the concentration of any cytokine measured.
The cervico-vaginal concentration of pro-inflammatory cytokines IL-8 and IL-6 increased prior to delivery at term and preterm and thus may be a useful tool to predict SPTB in asymptomatic women at increased risk of prematurity.
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.