J Korean Med Sci.  2020 Feb;35(7):e26. 10.3346/jkms.2020.35.e26.

The Identification of Immune-Related Plasma Proteins Associated with Spontaneous Preterm Delivery and Intra-Amniotic Infection in Women with Premature Cervical Dilation or an Asymptomatic Short Cervix

• Park H
• Hong S
• Yoo HN
• Kim YM
• Lee SJ
• Park KH

• KMID: 2470777
• DOI: http://doi.org/10.3346/jkms.2020.35.e26

Abstract

BACKGROUND
We aimed to investigate whether various immune-related plasma proteins, alone or in combination with conventional clinical risk factors, can predict spontaneous preterm delivery (SPTD) and intra-amniotic infection in women with premature cervical dilation or a short cervix (≤ 25 mm).
METHODS
This retrospective study included 80 asymptomatic women with premature cervical dilation (n = 50) or a short cervix (n = 30), who underwent amniocentesis at 17-29 weeks. Amniotic fluid (AF) was cultured, and maternal plasma was assayed for interleukin (IL)-6, matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and complements C3a and C5a, using enzyme-linked immunosorbent assay (ELISA) kits. The primary outcome measures were SPTD at < 32 weeks and positive AF cultures.
RESULTS
The plasma levels of IL-6, C3a, and C5a, but not of MMP-9 and TIMP-1, were significantly higher in women with SPTD at < 32 weeks than in those who delivered at ≥ 32 weeks. The women who delivered at < 32 weeks had more advanced cervical dilatation, and higher rates of antibiotic and tocolytic administration and were less likely to be given vaginal progesterone than those who delivered at ≥ 32 weeks. Using a stepwise regression analysis, a combined prediction model was developed, which included the plasma IL-6 and C3a levels, and cervical dilatation (area under the curve [AUC], 0.901). The AUC for this model was significantly greater than that for any single variable included in the predictive model. In the univariate analysis, plasma IL-6 level was the only significant predictor of intra-amniotic infection.
CONCLUSION
In women with premature cervical dilation or a short cervix, maternal plasma IL-6, C3a, and C5a levels could be useful non-invasive predictors of SPTD at < 32 weeks. A combination of these biomarkers and conventional clinical factors may clearly improve the predictability for SPTD, as compared with the biomarkers alone. An increased plasma level of IL-6 predicted intra-amniotic infection.

Keyword

Complement Fragments; Interleukin-6; Intra-Amniotic Infection; Plasma; Premature Cervical Dilation; Preterm Delivery

MeSH Terms

Amniocentesis
Amniotic Fluid
Area Under Curve
Biomarkers
Blood Proteins*
Cervix Uteri*
Complement System Proteins
Enzyme-Linked Immunosorbent Assay
Female
Humans
Interleukin-6
Interleukins
Labor Stage, First
Outcome Assessment (Health Care)
Plasma*
Pregnancy
Progesterone
Retrospective Studies
Risk Factors
Tissue Inhibitor of Metalloproteinase-1
Tissue Inhibitor of Metalloproteinases
Biomarkers
Blood Proteins
Complement System Proteins
Interleukin-6
Interleukins
Progesterone
Tissue Inhibitor of Metalloproteinase-1
Tissue Inhibitor of Metalloproteinases