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Mid-trimester cervical inflammatory milieu and sonographic cervical length
Amanda M Kalan1, Hyagriv N Simhan
1Department of Obstetrics and Gynecology, Magee Womens Hospital, Pittsburgh, PA 15213, USA.
American Journal of Obstetrics and Gynecology
|May 11, 2010
Summary
In women with a history of preterm birth, a higher ratio of proinflammatory to anti-inflammatory cytokines in cervical fluid is linked to shorter mid-trimester cervical length, indicating increased inflammation.
Area of Science:
- Reproductive immunology
- Obstetrics
- Biomedical science
Background:
- Cervical length is a key predictor of spontaneous preterm birth.
- The inflammatory environment within the cervix may influence cervical remodeling and length.
Purpose of the Study:
- To investigate the association between the balance of pro- and anti-inflammatory cytokines in cervical fluid and mid-trimester cervical length.
- To determine if cervical inflammation impacts cervical length in women at risk for preterm birth.
Main Methods:
- Prospective longitudinal cohort study of women with a prior spontaneous preterm birth.
- Serial ultrasound measurements of cervical length and cervical fluid cytokine levels were collected.
- Pro-/anti-inflammatory cytokine ratios were calculated and analyzed against cervical length using generalized estimating equations.
Main Results:
- A significant negative linear association was observed between the pro-/anti-inflammatory cytokine ratio and cervical length (beta = -0.09; P < .001).
- In 60% of visits, proinflammatory cytokines predominated over anti-inflammatory cytokines.
- This inflammatory balance and its association with cervical length remained consistent throughout the study period.
Conclusions:
- Shorter mid-trimester cervical length in women with a history of preterm birth is associated with a more proinflammatory cervical cytokine balance.
- Cervical inflammation may play a role in determining cervical length and preterm birth risk.
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