Early low cytokine levels may flag later infection. (May Signal Need for Intervention).

QUEBEC CITY--Low levels of proinflammatory cytokines collected from the cervixes of pregnant women early in gestation may be a precursor to intra-amniotic infection later in pregnancy, Dr. Hyagriv N. Simhan reported.

Poor maternal and neonatal outcomes such as cerebral palsy and sepsis are believed to be associated with intraamniotic infection, he said at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Nevertheless, infections are usually not detected until later in pregnancy, when symptoms are already present and the detrimental effects of infection are well underway, said Dr. Simhan, who is an ob.gyn. intern at the University of Pittsburgh and Magee-Womens Hospital, Pittsburgh.

This latest study suggests that the detection of low levels of proinflammatory cytokines interleukin-1[beta] (IL-1[beta]), interleukin-6 (IL-6), and interleukin-8 (IL-8) early in pregnancy may be a red flag to intervene before an infection develops.

In their preliminary investigation, Dr. Simhan and colleagues collected cervical samples from 403 women pregnant with singletons between 8 and 20 weeks' gestation who presented for their first prenatal care visit. Cervical swab samples were assayed for each of the proinflammatory cytokines as well as Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, bacterial vaginosis, and group B streptococcus.

During labor all the women were assessed for intraamniotic infection defined as having a temperature above 38[degrees]C and two of the following signs: maternal/fetal tachycardia, uterine tenderness, foul smelling discharge, or a white blood cell count of greater than 18,000.

Levels of all three proinflammatory cytokines measured at baseline were significantly lower among those women ...