The association between maternal cervicovaginal proinflammatory cytokines concentrations during pregnancy and subsequent early-onset neonatal infection
-
Jarosław Kalinka
Abstract
Objective: The aim of this study was to investigate the relationship between the concentration of selected proinflammatory cytokines (IL-1α, IL-1β, IL-6 and IL-8) in cervicovaginal fluid, as measured in midgestation, and the risk of early-onset neonatal infection (EONI).
Method: Cervicovaginal fluids were obtained from a cohort of 114 pregnant women at 22 to 34 weeks' gestation. The samples were analyzed for the concentrations of selected proinflammatory cytokines using standard enzyme-linked immunosorbent assay technique (ELISA). Lower genital tract microbiology was diagnosed using Gram stain method according to Spiegel's criteria and by culture.
Results: Mean gestational age at the time of sampling was 29.0 weeks. Mean time between sampling and delivery was 9.3 (SD 4.7) weeks. Bacterial vaginosis (BV) was diagnosed in 27.2% of subjects and M. hominis and U. urealyticum in 22.8% and 26.3%, respectively. Out of 114 women examined, 20 (17.5%) delivered newborns with EONI. Median cervicovaginal concentrations of IL-1α, IL-1β, IL-6 and IL-8 did not differ between women who delivered newborns with EONI as compared to women who delivered newborns without EONI. Women with pathological lower genital tract microflora and low IL-8 concentration (below 25th percentile) during pregnancy presented a significant risk of delivering newborns with EONI (OR=4.9; 95% CI, 1.1–22.8). Subjects with pathological lower genital tract microflora and a low concentration of more than one cytokine had the highest risk of delivering a newborn with EONI, OR=16.2, 95% CI, 1.1–234.0.
Conclusions: Cytokine measurement in cervicovaginal fluid in early gestation could be useful for predicting subsequent EONI only among pregnant women with lower genital tract infection. Maternal genital tract immune hyporesponsiveness as represented by low concentrations of proinflammatory cytokines may create a permissive environment for ascending infection and may lead to subsequent EONI.
References
1. Bergstrom S: Infection-related morbidities in the mother, fetus and neonate. J Nutr133 (2003) 1656S10.1093/jn/133.5.1656SSuche in Google Scholar PubMed
2. Brown N, SA Alvi, MG Elder, PR Bennett, MH Sullivan: Interleukin-1β and bacterial endotoxin change the metabolism of prostaglandin E2 and F2α in intact term fetal membranes. Placenta19 (1998) 625Suche in Google Scholar
3. Cox SM, MR King, L Casey, PC MacDonald: Interlekin-1β, -1α, and prostaglandins in vaginal/cervical fluids of pregnant women before and during labor. J Clin Endocrinol Metab77 (1993) 805Suche in Google Scholar
4. Dudley DJ, C Hunter, MD Mitchell, MW Varner: Amniotic fluid interleukin-10 (IL-10) concentration during pregnancy and with labor. J Reprod Immunol33 (1997) 147Suche in Google Scholar
5. Goncalves LF, T Chaiworapongsa, R Romero: Intrauterine infection and prematurity. Ment Retard Dev Disabil Res Rev8 (2002) 3Suche in Google Scholar
6. Hagbert H, C Mallard, B Jacobsson: Role of cytokine in preterm labour and brain injury. Br J Obstet Gynaecol112 (2005) 16Suche in Google Scholar
7. Hedtjarn M, C Mallard, P Arvidsson, H Hagberg: Interleukin-18 deficiency decreases white matter vulnerability in immature mice. Neurosci Lett373 (2005) 16Suche in Google Scholar
8. Hansen WR, A Drew, N Helsby, JA Keelan, TA Sato, MD Mitchell: Regulation of cytosolic phospholipase A2 expression by cytokines in human amnion cells. Placenta203 (1999) 303Suche in Google Scholar
9. Hillier SL, SS Witkin, MA Krohn, DH Watts, NB Kiviat, DA Eschenbach: The relationship of amniotic fluid cytokines and preterm delivery, amniotic fluid infection, histologic chorioamnionitis, and chorioamnion infection. Obstet Gynecol81 (1993) 941Suche in Google Scholar
10. Inglis SR, J Jeemias, K Kuno, K Lescale, Q Peeper, FA Chervenak, SS Witkin: Detection of tumor necrosis factor-α, interleukin-6, and fetal fibronectin in the lower genital tract during pregnancy: relation to outcome. Am J Obstet Gynecol171 (1994) 5Suche in Google Scholar
11. Jun JK, BH Yoon, R Romero, M Kim, JB Moon, SH Ki, JS Park: Interleukin 6 determination in cervical fluid have diagnostic and prognostic value in preterm premature rupture of membranes. Am J Obstet Gynecol183 (2000) 868Suche in Google Scholar
12. Kalinka J, W Sobala, M Wasiela, E Brzezińska-Błaszczyk: Decreased proinflammatory cytokines in cervicovaginal fluid, as measured in midgestation, are associated with preterm delivery. Am J Reprod Immunol2 (2005) 70Suche in Google Scholar
13. Kalinka J, T Laudanski, W Hanke, M Wasiela: Do microbiological factors account for poor pregnancy outcome among unmarried pregnant women in Poland? Fetal Diagnosis and Therapy18 (2003) 345Suche in Google Scholar
14. Mallard C, AK Welin, D Peebles, H Hagberg, I Kjellmer: White matter injury following systemic endotoxemia or asphyxiain fetal sheep. Neurochem Res28 (2003) 215Suche in Google Scholar
15. Minagawa K, Y Tsuji, H Ueda, K Koyama, K Tanizawa, H Okamura, T Hashimoto-Tamaoki: Possible correlation between high levels of IL-18 in the cord blood of pre-term infants and neonatal development of preventricular leukomalacia and cerebral palsy. Cytokine17 (2002) 164Suche in Google Scholar
16. Molnar M, R Romero, F Hertelendy: Interleukin-1 and tumor necrosis factor stimulate arachidonic acid release and phospholipid metabolism in human myometrial cells. Am J Obstet Gynecol169 (1993) 825Suche in Google Scholar
17. Ogawa M, H Hirano, H Tsubaki, H Kodama, T Tanaka: The role of cytokines in ripening: correlations between the concentrations of cytokines and hyaluronic acid in cervical mucous and the induction of hyaluronic acid production by inflammatory cytokines by human cervical fibroblasts. Am J Obstet Gynecol179 (1998) 105Suche in Google Scholar
18. Park KH, BH Yoon, SS Shim, JK Jun, HC Syn: Amniotic fluid tumor necrosis factor-α is a marker for the prediction of early-onset neonatal sepsis in preterm labour Gynecol Obstet Invest58 (2004) 84Suche in Google Scholar
19. Putz I, M Lohbreyer, M Winkler, W Rath: Appearance of inflammatory cytokines interleukin-1β and interleukin-6 in amniotic fluid during labor and in intrauterine pathogen colonization. Z Geburtschilfe Neonatol202 (1998) 14Suche in Google Scholar
20. Rizzo G, A Capponi, D Rinaldo, D Tedeschi, D Arduini, C Romanini: Interleukin-6 concentration in cervical secretions identify microbial invasion of the amniotic cavity in patients with preterm labour and intact membranes. Am J Obstet Gynecol175 (1996) 812Suche in Google Scholar
21. Rizzo G, A Capponi, A Vlachopoulou, E Angelini, C Grassi, C Romanini: Interleukin-6 concentration in cervical secretions in the prediction of intrauterine infection in preterm premature rupture of membranes. Gynecol Obstet Invest46 (1998) 91Suche in Google Scholar
22. Romero R, BH Yoon, JS Kenney, R Gomez, AC Allison, PB Sehgal: Amniotic fluid interleukin-6 determination are of diagnostic and prognostic value in preterm labour. Am J Reprod Immunol30 (1993) 167Suche in Google Scholar
23. Romero R, T Chaiworapongsa, J Espinoza: Micronutrients and intrauterine infection, preterm birth and the fetal inflammatory response syndrom. J Nutr133 (2003) 1668SSuche in Google Scholar
24. Simpson KL, JA Keelan, MD Mitchell: Labour-associated changes in the regulation of production of immunomodulators in human amnion by glucocorticoids, bacterial lipopolysaccharide and pro-inflammatory cytokines. J Reprod Fertil116 (1999) 321Suche in Google Scholar
25. Simhan HN, SN Caritis, MA Krohn, SL Hillier: Decreased cervical proinflammatory cytokines permit subsequent upper genital tract infection during pregnancy. Am J Obstet Gynecol189 (2003) 560Suche in Google Scholar
26. Spiegel CA, R Amsel, KK Holmes: Diagnosis of bacterial vaginosis by direct gram stain of vaginal fluid. J Clin Endocrinol Metab18 (1983) 170Suche in Google Scholar
27. Ungerer RL, O Lincetto, W McGuire, H Saloojee, AM Gulmezoglu: Prophylactic versus selective antibiotics for term newborn infants of mothers with risk factors for neonatal infection. Cochrane Database Syst Rev 18 (2004) CD00395710.1002/14651858.CD003957.pub2Suche in Google Scholar PubMed
28. Yoon BH, R Romero, JS Park, CJ Kim, SH Kim, JH Choi, TR Han: Fetal exposure to an intra-amniotic inflammation and the developmentof cerebral palsy at the age of three years. Am J Obstet Gynecol182 (2000) 675Suche in Google Scholar
©2006 by Walter de Gruyter Berlin New York
Artikel in diesem Heft
- Non-selective fetal reduction is malpractice
- Guidelines for the management of spontaneous preterm labor
- Accuracy of second trimester fetal head circumference and biparietal diameter for predicting the time of spontaneous birth
- The association between maternal cervicovaginal proinflammatory cytokines concentrations during pregnancy and subsequent early-onset neonatal infection
- Leukocytosis might precede in-hospital eclampsia in preeclamptic women who do not receive magnesium sulfate
- Randomized prospective comparative study of ursodeoxycholic acid and S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis of pregnancy
- Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies
- Fetal behavior analyzed by ultrasonic actocardiogram in cases with central nervous system lesions
- Early weight gain does not decrease the incidence of low birth weight and small for gestational age triplets in mothers with normal pre-gestational body mass index
- Umbilical artery pulsatility index: reliability at different sampling sites
- Inferior vena cava diameter pulse waveforms in the human fetus: relationship with flow velocity waveform
- A trial of preventing early- and late-onset Group B streptococcal sepsis with combined intrapartum chemoprophylaxis and universal neonatal screening
- Impact of prenatal urinomas in patients with posterior urethral valves and postnatal renal function
- Congress Calendar
Artikel in diesem Heft
- Non-selective fetal reduction is malpractice
- Guidelines for the management of spontaneous preterm labor
- Accuracy of second trimester fetal head circumference and biparietal diameter for predicting the time of spontaneous birth
- The association between maternal cervicovaginal proinflammatory cytokines concentrations during pregnancy and subsequent early-onset neonatal infection
- Leukocytosis might precede in-hospital eclampsia in preeclamptic women who do not receive magnesium sulfate
- Randomized prospective comparative study of ursodeoxycholic acid and S-adenosyl-L-methionine in the treatment of intrahepatic cholestasis of pregnancy
- Coagulation-fibrinolysis is more enhanced in twin than in singleton pregnancies
- Fetal behavior analyzed by ultrasonic actocardiogram in cases with central nervous system lesions
- Early weight gain does not decrease the incidence of low birth weight and small for gestational age triplets in mothers with normal pre-gestational body mass index
- Umbilical artery pulsatility index: reliability at different sampling sites
- Inferior vena cava diameter pulse waveforms in the human fetus: relationship with flow velocity waveform
- A trial of preventing early- and late-onset Group B streptococcal sepsis with combined intrapartum chemoprophylaxis and universal neonatal screening
- Impact of prenatal urinomas in patients with posterior urethral valves and postnatal renal function
- Congress Calendar
