Cervicovaginal interleukin-6, tumor necrosis factor-alpha, and interleukin-2 receptor as markers of preterm delivery.

Abstract

Preterm delivery is a common obstetric problem (1), and infants born prematurely are at increased risk for long-term disability and death (2). Clinical indicators of preterm delivery are neither sensitive nor specific (3). Fetal fibronectin (fFN) testing of cervicovaginal fluid is the only Food and Drug Administration-cleared test for prediction of preterm delivery. A negative fFN test ( 99% negative predictive value for delivery within 7 or 14 days of testing (4)(5). The negative result enables physicians to avoid unnecessary interventions, but the fFN test is costly (more than $100 per test). Cytokines have been investigated as biomarkers of impending preterm delivery and may favor preterm birth by stimulating prostaglandin synthesis (6)(7). Increased serum and amniotic fluid concentrations of several cytokines have been reported in women with preterm labor (8)(9)(10)(11)(12). The use of cervicovaginal fluid has been suggested as an alternative to amniotic fluid testing because this fluid is thought to be released through mechanical or inflammation-mediated damage to the membranes or placenta before birth (13). Cytokines may be released into cervicovaginal fluid during the breakdown of the chorio-decidual adhesion or from an inflammatory reaction in the same area. Few studies have been performed on symptomatic women (14)(15)(16)(17)(18)(19)(20). The objective of this study was to examine the potential usefulness of cervicovaginal interleukin-6 (IL-6), tumor necrosis factor-α (TNFα), and interleukin-2 receptor (IL-2R) in the prediction of delivery in symptomatic women within 14 days of testing. This was a retrospective cohort study of samples for physician-ordered cervicovaginal fFN tests received by the Barnes-Jewish Hospital laboratory between February 2001 and December 2002. Cervicovaginal fluid was …