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Am J Perinatol 2015; 32(07): 689-694
DOI: 10.1055/s-0034-1395478
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Interpregnancy Interval and Anti-inflammatory Cervical Cytokines among Women with Previous Spontaneous Preterm Birth

Raj Shree
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh, Pittsburgh, Pennsylvania
,
Hyagriv N. Simhan
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh, Pittsburgh, Pennsylvania
› Author Affiliations
Further Information

Publication History

15 May 2014

03 September 2014

Publication Date:
08 December 2014 (online)

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Abstract

Objective Both history of spontaneous preterm birth (sPTB) and shorter interpregnancy intervals (IPIs) increase the risk of recurrent sPTB. Mechanisms underlying the association between IPI and recurrent sPTB are unknown. We have previously demonstrated that higher concentrations of cervical anti-inflammatory cytokines are a risk factor for sPTB and upper genital tract inflammation. Here, we examine the association between IPI and cervical anti-inflammatory cytokines among women with previous sPTB.

Patients and Methods  A prospective cohort of 73 women with previous sPTB and cervical interleukins (IL-4, IL-10, and IL-13) measured at < 16 weeks. Using the published principal factor analysis, the anti-inflammatory (ANTI) score was calculated. From our previous work, higher ANTI scores increase the subsequent risk of sPTB. IPI was the time from the previous birth to the conception of current pregnancy. Confounders included education level, marital status, gonorrhea, chlamydia, body mass index, race, and cigarette smoking. IPI and ANTI score were analyzed using univariable and multivariable analyses.

Results There was a significant negative linear relation between IPI and ANTI score (β = −0.075, p = 0.017). This persisted after adjustment for confounders (p = 0.02). As IPI decreases by 1 month, the ANTI-score–associated risk of sPTB increases approximately by 4%.

Conclusion Among women with previous sPTB, there was a significant negative linear relation between IPI and ANTI score.

Keywords

cervix - cytokines - inflammation - interpregnancy interval - preterm birth
 

  • References

  • 1 Berhman RE, Stith Butler A , eds. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press; 2007
    Google Scholar
  • 2 Ananth CV, Joseph KS, Oyelese Y, Demissie K, Vintzileos AM. Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Obstet Gynecol 2005; 105 (5 Pt 1) 1084-1091
    CrossrefPubMedGoogle Scholar
  • 3 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606) 75-84
    CrossrefPubMedGoogle Scholar
  • 4 Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988; 319 (15) 972-978
    CrossrefPubMedGoogle Scholar
  • 5 Simhan HN, Caritis SN, Krohn MA, Martinez de Tejada B, Landers DV, Hillier SL. Decreased cervical proinflammatory cytokines permit subsequent upper genital tract infection during pregnancy. Am J Obstet Gynecol 2003; 189 (2) 560-567
    CrossrefPubMedGoogle Scholar
  • 6 Genc MR, Witkin SS, Delaney ML , et al. A disproportionate increase in IL-1beta over IL-1ra in the cervicovaginal secretions of pregnant women with altered vaginal microflora correlates with preterm birth. Am J Obstet Gynecol 2004; 190 (5) 1191-1197
    PubMedGoogle Scholar
  • 7 Simhan HN, Krohn MA. First-trimester cervical inflammatory milieu and subsequent early preterm birth. Am J Obstet Gynecol 2009; 200 (4) e1-e4
    PubMedGoogle Scholar
  • 8 Simhan HN, Bodnar LM, Kim KH. Lower genital tract inflammatory milieu and the risk of subsequent preterm birth: an exploratory factor analysis. Paediatr Perinat Epidemiol 2011; 25 (3) 277-282
    CrossrefPubMedGoogle Scholar
  • 9 Zhu BP, Rolfs RT, Nangle BE, Horan JM. Effect of the interval between pregnancies on perinatal outcomes. N Engl J Med 1999; 340 (8) 589-594
    CrossrefPubMedGoogle Scholar
  • 10 Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA 2006; 295 (15) 1809-1823
    CrossrefPubMedGoogle Scholar
  • 11 DeFranco EA, Stamilio DM, Boslaugh SE, Gross GA, Muglia LJ. A short interpregnancy interval is a risk factor for preterm birth and its recurrence. Am J Obstet Gynecol 2007; 197 (3) e1-e6
    PubMedGoogle Scholar
  • 12 Getahun D, Strickland D, Ananth CV , et al. Recurrence of preterm premature rupture of membranes in relation to interval between pregnancies. Am J Obstet Gynecol 2010; 202 (6) e1-e6
    PubMedGoogle Scholar
  • 13 Simhan HN, Bodnar LM, Krohn MA. Paternal race and bacterial vaginosis during the first trimester of pregnancy. Am J Obstet Gynecol 2008; 198 (2) e1-e4
    PubMedGoogle Scholar
  • 14 Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991; 29 (2) 297-301
    PubMedGoogle Scholar
  • 15 Conde-Agudelo A, Rosas-Bermudez A, Castaño F, Norton MH. Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. Stud Fam Plann 2012; 43 (2) 93-114
    CrossrefPubMedGoogle Scholar
  • 16 Sundtoft I, Sommer S, Uldbjerg N. Cervical collagen concentration within 15 months after delivery. Am J Obstet Gynecol 2011; 205 (1) e1-e3
    CrossrefPubMedGoogle Scholar