First-trimester cervical inflammatory milieu and subsequent early preterm birth

OBJECTIVE: Our objective was to explore the relation between the pro- and antiinflammatory cervical cytokine balance in early pregnancy and subsequent early preterm birth. STUDY DESIGN: In this prospective cohort of 218 pregnant women who were enrolled in the first trimester, we assayed cervical concentrations of interleukin-1 alpha, -1 beta, -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. RESULTS: 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. CONCLUSION: Women with a relatively hyporesponsive cervical inflammatory milieu in early pregnancy are at higher risk of subsequent early spontaneous preterm birth.