Abstract
Introduction: Inflammation might be an important underlying cause of preterm birth. Our aim is to explore whether vaginal administration α-lipoic acid reduces cervical inflammation and shortening after primary tocolysis.Materials and methods: Singleton pregnancies between 24–30 weeks remaining undelivered after hospitalization for preterm labor were randomly allocated to placebo (20 women, 15 analyzed) or vaginal ALA 400 mg (active ingredient 10 mg) daily (20 women, 17 analyzed) for 30 days. A cervical swab to quantify pro-inflammatory (IL1, IL2, IL6, IL8, TNFα) and anti-inflammatory (IL4, IL10) cytokines as well as transvaginal ultrasound cervical length measurement (CL) were performed before and after treatment.Results: The % changes of pro-inflammatory cytokines do not differ between treatment groups, while IL4 significantly increases by vaginal ALA in comparison to placebo (118.0 ± 364.3% versus 29.9 ± 103.5%, p = 0.012). Combined anti-inflammatory cytokines show same trend (292.5 ± 208.5% versus 64.5 ± 107.4, p = 0.03). CL remains similar in vaginal ALA group (from 23.1 ± 6.6 to 20.80 ± 7.9 mm), while it significantly decreased in placebo group (from 20.4 ± 6.5 to 13.8 ± 7.5 mm, p < 0.001 versus Baseline; p = 0.003 versus vaginal ALA).Conclusion: Vaginal ALA significantly stimulates anti-inflammatory ILs in the cervix of undelivered women after a preterm labor episode. This effect is associated with a stabilization of the CL.
Highlights
Inflammation might be an important underlying cause of preterm birth
No significant differences were found in subjects that reach final follow up visit [17/20 (85%) in vaginal Alpha-lipoic acid (ALA) group, 15/20 (75%) in placebo group, p=0.72]
4.1 Principal findings of the study In this pilot study, we have shown that vaginal ALA administration is associated with a specific anti-inflammatory effect at the cervical level in comparison to placebo, namely stimulating antiinflammatory cytokines
Summary
Inflammation might be an important underlying cause of preterm birth. Our aim is to explore whether vaginal administration α-lipoic acid reduces cervical inflammation and shortening after primary tocolysis. AC Conclusion: Vaginal ALA significantly stimulates anti-inflammatory ILs in the cervix of undelivered women after a preterm labor episode. This effect is associated with a stabilization of the. Several studies have demonstrated the efficacy of either TE vaginal progesterone (P) or intramuscular 17α-hydroxyprogesterone caproate for the prevention of P PTB in asymptomatic women with singleton pregnancy with a history of a previous preterm birth E [5-7]. The efficacy of C progestogens in women remaining undelivered after an episode of PTL remain to be demonstrated, A as controversial data have been published [9-12] For this reason new approaches to PTB prevention are needed [13], namely in the field of the so called “secondary or maintenance
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