Recent study demonstrated that the intensity of amniotic fluid inflammatory response decreases in the setting of acute histologic chorioamnionitis(acute-HCA) with increasing gestational age(GA). However, there is no information about whether the intensity of fetal inflammatory response(FIR) in the same setting of placental inflammatory condition decreases with GA. We hypothesized that the intensity of FIR would decrease with increasing GA in the setting of funisitis, but not acute-HCA without funisitis.
FIR was examined in 209 singleton preterm-pregnancies(23.1< GA at delivery <36wks) with acute-HCA or funisitis and with preterm labor or preterm-PROM. Study population was divided into GA at delivery ≤30wks(n=61), 30-34wks(n=87), and 34-36wks(n=61). Acute-HCA was diagnosed in the presence of inflammation in chorio-decidua(CD), amnion or chorionic plate, and funisitis was defined as inflammation in umbilical cord. FIR was determined by umbilical cord plasma(UCP) CRP concentration at birth.
UCP CRP concentrations at birth were less intense at higher GA in patients with acute-HCA or funisitis(P<.005). Median UCP CRP concentration(ng/ml) at birth decreased in patients with funisitis (840.6,[7.6-10897.4] vs. 368.8,[4.9-5555.0] vs. 128.2,[2.2-4533.9]; P<.05), but not acute-HCA without funisitis(36.1,[1.9-7401.8] vs. 23.8,[3.0-2702.4] vs. 15.2,[3.9-1295.5]; P>.1), with increasing GA. Moreover, median UCP CRP concentration at birth decreased in patients with inflammation of the compartment beyond CD(i.e., amnionitis, chorionic plate inflammation or funisitis)(711.9,[7.6-10897.4] vs. 321.1,[3.0-5555.0] vs. 124.9,[2.2-4533.9]; P<.05), but not inflammation restricted to the chorio-decidua(19.0,[1.9-2586.7] vs. 22.1,[4.0-1257.4] vs. 12.5,[3.9-1075.3]; P>.1), with GA. Furthermore, there was a significant inverse relationship between GA and UCP CRP concentrations at birth in patients with funisitis(r=-0.280, P<.0005) and inflammation of the compartment beyond CD(r=-0.253, P=.005).
UCP CRP concentrations at birth in the context of funisitis, but not acute-HCA without funisitis, distinctly decrease throughout preterm-gestation. This finding suggests that FIR decreases even in the same setting of funisitis with increasing GA.
© 2016 Published by Elsevier Inc.