Cervicovaginal fluid cytokines as predictive markers of preterm birth in symptomatic women

Objective Here, we investigated whether cytokines in the cervicovaginal fluid (CVF) can be predictive markers of preterm birth (PTB). Methods A multi-center prospective cohort study was conducted on 59 singleton pregnant women hospitalized for preterm labor (PTL) and/or preterm premature rupture of membranes (pPROM) between 22 weeks and 36 weeks 6 days of gestation from 2014 to 2015. The levels of 13 inflammatory cytokines (macrophage inflammatory protein [MIP]-1 alpha, MIP-1 beta, tumor necrosis factor [TNF]-alpha, interleukin [IL]-1 beta, IL-6, IL-8, IL-17 alpha, granulocyte colony stimulating factor [G-CSF], IL-7, IL-4, IL-5, IL-10, and IL-13) were measured using a multiplex bead-based immunoassay and that of fetal fibronectin (fFN) was measured using enzyme-linked immunosorbent assay (ELISA). Statistical analyses were performed using Student's t-test, Mann-Whitney U test, Pearson's correlation, and receiver operating characteristic (ROC) curve analysis in SPSS version 20.0. Results Among the 13 cytokines assessed, the levels of 3 cytokines (MIP-1 alpha, IL-6, and IL-7) were negatively correlated with gestational age at delivery (P=0.028, P=0.002, and P=0.018, respectively). Sensitivities of MIP-1 alpha, IL-6, and IL-17a were 70%, 80%, and 75%, respectively, and their specificities were 57%, 65%, and 69%, respectively. The sensitivity and specificity of fFN were 33% and 95%, respectively. Conclusion In symptomatic women diagnosed with PTL and/or pPROM, cytokines from cervicovaginal fluid, especially IL-6 and IL-17 alpha, could be better predictive markers of PTB than fFN.