First-trimester cervical inflammatory milieu and subsequent early preterm birth.

Abstract

Our objective was to explore the relation between the pro- and antiinflammatory cervical cytokine balance in early pregnancy and subsequent early preterm birth. In this prospective cohort of 218 pregnant women who were enrolled in the first trimester, we assayed cervical concentrations of interleukin-1alpha, -1beta, -6, -4, -10, and -13. Based on these cytokines, we categorized subjects into 1 of 3 strata: high proinflammatory/low antiinflammatory, high antiinflammatory/low proinflammatory, or balanced. The primary outcome of interest was preterm birth at < 34 weeks' gestation. Women in the high antiinflammatory/low proinflammatory stratum had a subsequent odds ratio for preterm birth < 34 weeks' gestation of 7.7 (95% CI, 4.9-9.1; P = .01), after adjustment for marital status, smoking, bacterial vaginosis, maternal race, and less than high school education. Women with a relatively hyporesponsive cervical inflammatory milieu in early pregnancy are at higher risk of subsequent early spontaneous preterm birth.