Abstract
Approximately 40% of cases of spontaneous preterm birth (sPTB) are associated with ascending intrauterine infections. The cervix serves as a physical and immunological gatekeeper, preventing the ascent of microorganisms from the vagina to the amniotic cavity. The cervix undergoes remodeling during pregnancy. It remains firm and closed from the start until the late third trimester of pregnancy and then dilates and effaces to accommodate the passage of the fetus during delivery. Remodeling proceeds appropriately and timely to maintain the pregnancy until term delivery. However, risk factors, such as acute and chronic infection and local inflammation in the cervix, may compromise cervical integrity and result in premature remodeling, predisposing to sPTB. Previous clinical studies have established bacterial (i.e., chlamydia, gonorrhea, mycoplasma, etc.) and viral infections (i.e., herpesviruses and human papillomaviruses) as risk factors of PTB. However, the exact mechanism leading to PTB is still unknown. This review focuses on: (1) the epidemiology of cervical infections in pregnant patients; (2) cellular mechanisms that may explain the association of cervical infections to premature cervical ripening and PTB; (3) endogenous defense mechanisms of the cervix that protect the uterine cavity from infection and inflammation; and (4) potential inflammatory biomarkers associated with cervical infection that can serve as prognostic markers for premature cervical ripening and PTB. This review will provide mechanistic insights on cervical functions to assist in managing cervical infections during pregnancy.
Highlights
Preterm birth (PTB) is defined as live birth before the completion of 37 weeks of pregnancy [1]
To summarize the evidence on the role of infection and inflammation in the cervix in the pathogenesis of PTB, we conducted this review, which focused on: [1] the epidemiology of cervical infections in pregnant patients; [2] cellular mechanisms that may explain the association of cervical infections to premature cervical ripening and PTB; [3] endogenous defense mechanisms of the cervix to protect the uterine cavity from infection and inflammation; and [4] potential inflammatory biomarkers associated with cervical infection that can serve as prognostic markers for premature cervical ripening and PTB
A retrospective populationbased study showed that Human papillomavirus (HPV) infections before or during pregnancy were associated with PTB [adjusted odds ratio: 1.19, 95% CI: 1.01–1.42], PPROM, premature rupture of membranes, and neonatal mortality [71]
Summary
Preterm birth (PTB) is defined as live birth before the completion of 37 weeks of pregnancy [1]. It remains a global public health concern, affecting almost 15 million babies annually [2]. It is the leading cause of death in children younger than 5 years of age. Preterm neonates have a greater risk of developing neonatal morbidities, such as respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, sepsis, and infections [3]. Studies have shown that prematurity may cause a greater risk of developing comorbidities in adulthood, such as cardiometabolic, respiratory, and neuropsychiatric disorders [3,4,5]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
