Maternal C-reactive Protein Concentrations Research Articles

Role of maternal serum c-reactive protein levels in early second trimester as a marker of preterm labour: A study protocol

Preterm labour is a birth that occurs between 22 and 37 weeks after conception. The primary cause of infant death is preterm birth (PTD), which is linked to long-term neurodevelopmental and behavioural effects for preterm survivors. A maternal vascular disease pathway and an inflammation/infection pathway are two suggested pathways that have collected sufficient evidence. The identification of women who are more likely to develop PTD and the understanding of the underlying physiological mechanisms would be made possible by reliable biomarkers for these pathways. Systemic maternal infections cause elevated levels of inflammatory cytokines, which then drive the creation of prostaglandins, which can cause cervical ripening and uterine contractions that result in preterm birth. Women with signs of preterm labour have been found to have high serum levels of proinflammatory which have been prospectively linked to preterm birth. A non-specific biomarker of inflammation, C-reactive protein (CRP) is an acute phase reactant in the innate immune response. The production of C-reactive protein, a serological marker that is readily identifiable, occurs largely in the hepatocytes in response to cytokine releases from the inflammatory site. Cytokines released, by an intrauterine infection go through the maternal bloodstream to the liver, where they activate the production of CRP. Forty-eight hours after stimulation the acute-phase response has reached its maximum and a meaningful measurement can be made from a blood sample. Although the exact cause of inflammation is unknown, modest and long-lasting elevations of CRP have been linked to a range of illnesses, including normal pregnancy. Elevated CRP levels in the peripheral circulation have been connected to the presence of intrauterine infection. It has been investigated to diagnose subclinical infections using the maternal CRP concentration. The purpose of this study is to determine the link between maternal serum CRP and subsequent preterm birth in single pregnant women.

Associations between prenatal maternal stress, maternal inflammation during pregnancy, and children’s internalizing and externalizing symptoms throughout childhood

BackgroundMaternal immune activation is a potential mechanism underlying associations between maternal stress during pregnancy and offspring mental health problems. This study examined associations between prenatal maternal stress, maternal inflammation during pregnancy, and children’s internalizing and externalizing symptoms from 3 to 10 years of age, and whether maternal inflammation mediated the associations between prenatal maternal stress and children’s internalizing and externalizing symptoms. MethodsThis study comprised 4,902 mother–child dyads in the Generation R study. Prenatal maternal stress was assessed using self-reported data collected during pregnancy and analyzed as a latent variable consisting of four stress domains. Maternal inflammation during pregnancy was assessed using serum concentrations of C-reactive protein (CRP) measured at a median of 13.5 weeks’ gestation. Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist (CBCL) by maternal report at ages 3 years, 5 years, and 10 years; paternal-reported CBCL data were also available at 3 years and 10 years. ResultsPrenatal maternal stress was associated with maternal-reported internalizing and externalizing symptoms of the child at 3, 5, and 10 years of age, and with paternal-reported internalizing and externalizing symptoms at 3 and 10 years. Prenatal maternal stress was associated with maternal CRP concentrations prior to, but not after, covariate adjustment. Maternal CRP concentrations during pregnancy were associated with paternal-reported internalizing symptoms of offspring at 10 years of age prior to, but not after, covariate adjustment. There was no evidence that CRP concentrations mediated the associations between prenatal maternal stress and children’s internalizing or externalizing symptoms. ConclusionsMaternal stress during pregnancy is associated with higher levels of internalizing and externalizing symptoms in children, but this association is not because of differences in maternal immune activation linked to maternal stress. Replication of these findings in other cohorts is required; examination of other biomarkers or variation in immune activity during pregnancy would also benefit from further exploration.

C-reactive Protein Level in Bangladeshi Preeclamptic Patients and Its Comparison with Trimester-Matched Normal Pregnancy

Introduction with objective: Preeclampsia is a major cause of maternal and fetal morbidity and mortality in Bangladesh. This study aimed to estimate C-reactive protein (CRP) level among patients with preeclampsia and to compare with those of trimester-matched normal pregnancy. Materials and Methods: : This cross-sectional study was done from January 2005 to December 2006 at the different tertiary care hospital at Dhaka. A total of 33 preeclamptic and 33 normal pregnant women in the third trimester were enrolled in the study. The PE patients were divided into two groups: mild hypertension [diastolic blood pressure (DBP) <110 mm Hg] and severe hypertension (DBP _110 mm Hg). Similarly the patients were divided into two groups on the basis of proteinuria, group I ( 2+>=1gm/l) and group II (3+_3gm/l). Both PE and control groups were matched for their age and parity. Estimation of serum CRP was done by Turbulometry method. Results: CRP concentration (mg/l) was 4.55±2.83 in control group and 23.52±24.85 in PE group which was significantly higher than in control group. CRP level was significantly higher (p<0.001) in severe PE than in mild PE group. Significant difference was also seen between the groups subdivided on the basis of proteinuria (p<0.05). In the whole population CRP values showed significant positive correlation with systolic and diastolic blood pressure (p<0.001) and significant negative correlation with gestational age at delivery and birth weight (gestational age: p<0.05, birth weight: p<0.001). Conclusion: Maternal CRP concentration was higher in patients with preeclampsia and was correlated with disease severity. Medicine Today 2023 Vol.35(1): 1-6

Association between Serum C-reactive Protein and Pre-eclampsia

Among the common disorders of pregnancy, Pre-eclampsia is important one which causes significant maternal and perinatal morbidity and mortality. Its incidence is still high in the developing countries. The triad of high blood pressure, edema and albuminuria is neither specific nor sensitive enough; therefore, a reliable biochemical marker is needed to solve the problem. C-reactive protein(CRP), a marker of tissue damage and inflammation, is elevated in serum in overt preeclampsia. The present study is aimed to explore the association of high maternal serum C-reactive protein (CRP) level with preeclampsia and correlation with the severity of pre-eclamptic process. A total of 60 pregnant women constituting 30 pre-eclamptic (case) and 30 normal (control) pregnant women in the third trimester were enrolled in this study. Both the groups were matched for their age, parity and other baseline characteristics. More than three quarters (76.70%) of the case group exhibited raised serum CRP, which was 20% in control group (p=0.001). CRP was elevated about 13 fold higher than that in the normal pregnant women. The mean systolic and diastolic blood pressure were significantly higher in case group (154±12 mm of Hg) vs (107±7 mm of Hg) in control group (p<_0.001) and serum level of CRP bears linear relationship with both systolic and diastolic blood pressures. Preeclamptic women with higher serum CRP level were at a significantly (p<0.001) lower gestational age than control. Twenty two (73.30%) cases had gestational age <37 weeks (p=0.302) and 66.70% control group had gestational age > 37 weeks. The hypothesis of the study was supported by the study findings that maternal CRP concentration was higher in women with preeclampsia and was correlated with disease progression as evidenced by the investigative analysis. Faridpur Med. Coll. J. Jan 2020;15(2): 58-61

Bacterial-Culture-Negative Subclinical Intra-Amniotic Infection Can Be Detected by Bacterial 16S Ribosomal-DNA-Amplifying Polymerase Chain Reaction.

Comprehensive analysis of bacterial DNA has enhanced our understanding of the maternal microbiome and its disturbances in preterm birth although clinical utility of these techniques remains to be determined. We tested whether a broad-range polymerase chain reaction (PCR) technique is useful for detection of culture-negative intra-amniotic infection (IAI). Pregnant women who underwent amniocentesis for the management of preterm birth with or without premature rupture of membranes. Bacterial 16S ribosomal DNA in the amniotic fluid was detected by PCR using primers for a sequence shared by Ureaplasma, Mycoplasma, and other bacteria. Sixty-four women were enrolled, 9 of whom were culture-positive. Of the 55 culture-negative women, 13 were PCR-positive and exhibited significantly higher interleukin 6 and 8 levels and lower glucose levels in the amniotic fluid than the remaining 42 women did, who were PCR- and culture-negative. C-reactive protein concentrations were elevated in cord and neonatal blood in the culture-negative, PCR-positive subgroup, whereas maternal C-reactive protein concentrations, white blood cell counts, and body temperatures were alike. The placental inflammation score (Blanc stage≥2) was significantly higher in the PCR-positive than in PCR-negative subgroup. This PCR-based method could be useful for identifying bacterial-culture-negative subclinical IAI and could help with predicting the severity of IAI.

Maternal C-reactive protein concentrations during pregnancy and birth weight in a prospective cohort in Rio de Janeiro, Brazil

Objective: To evaluate the association between maternal C-reactive protein (CRP) concentrations during pregnancy and birth weight (BW) Z-score.Methods: A prospective cohort of pregnant women were followed at 5–13 (n = 203), 20–26 (n = 181), and 30–36 (n = 181) gestational weeks and at 30–45 d postpartum. Maternal CRP concentrations were assessed three times during pregnancy using immunoturbidimetric methods (ultra-sensitive kits). BW Z-score and newborns classified as small for gestational age (SGA) were evaluated according to Intergrowth-21st curves. Statistical analyses included SGA rates, BW Z-score means (SD) and a two-stage procedure: (1) a linear mixed-effect model (LME) to predict CRP intercept (mean exposure level) and slope (trend of change during pregnancy); and (2) a multiple linear regression model with BW Z-score as the outcome and CRP intercept and slope exposures.Results: A total of 4.4% (n = 9) women delivered SGA newborns. The mean BW was 3282.0 (37.3) g, and the mean gestational age at delivery was 38.8 (0.1) weeks. Women in the third tertile of the CRP rate of change gave birth to infants with a mean BW Z-score that was lower than those in the first/second tertiles (0.226 versus 0.381; p = 0.324). For the adjusted baseline CRP (β = 0.08; 95% CI: 0.03–0.14), the CRP trend of change was inversely associated with the BW Z-score (β= −3.77; 95% CI: −5.45 to −2.10).Conclusions: The maternal CRP trend of change during pregnancy was negatively associated with BW Z-score.

55 Exercise effects on inflammation during pregnancy: A systematic review

Introduction C-reactive protein (CRP) during pregnancy has been associated with adverse maternal outcomes such as preeclampsia and gestational diabetes mellitus. Increased physical activity and exercise training have shown to decrease circulating levels of CRP. The association between maternal exercise and CRP has not been adequately investigated. Objective To review the literature to investigate the maternal exercise effects on CRP responses during pregnancy. Methods This systematic review was designed according to PRISMA (PROSPERO registration CRD42016039618). Eligible studies were identified from MEDLINE, EMBASE, Web of Science, Scopus, COCHRANE CENTRAL, Scielo and SportDiscus up to May 2016 without year of publication and language limitations. The main MeSH terms were the following: “exercise”, “motor activity”, “physical activity”, “pregnancy”, “gestational”, “maternal” and “C-reactive protein”. Inclusion criteria were studies conducted in pregnant women who were engaged in any type of exercise or physical activity and report CRP values. The extraction and risk of bias assessment were carried out by two independent reviewers. A total of 344 studies were found, 147 of which were excluded as duplicates, and 191 studies were excluded based on title, abstract and full-text. Six studies met the inclusion criteria and were included in the present systematic review. Results Across six studies, 1276 pregnant women were included. The maternal exercise intensity ranged from light to vigorous. Out of six studies, two were randomized controlled trials that reported decrease in maternal CRP concentrations after an exercise intervention. Four studies were prospective observational studies that reported no difference in maternal CRP values with exercise (one study) or decrease in maternal CRP values when the exercise was added to the prenatal standard care. Conclusion In conclusion, the majority of the studies found in the present systematic review reported a decrease in CRP concentrations after an exercise intervention before or during pregnancy. These responses indicate a trend towards a protective effect of exercise and physical activity on inflammation during pregnancy. Disclosure of interest None declared.

Maternal mid-pregnancy C-reactive protein and risk of autism spectrum disorders: the early markers for autism study.

Maternal pregnancy levels of the inflammatory marker C-reactive protein (CRP) has been previously associated with autism spectrum disorder (ASD) in the offspring. We conducted a population-based nested case–control study with 500 children with ASD, 235 with developmental delay (DD) and 580 general population (GP) controls to further investigate whether elevated CRP during pregnancy increases the risk of ASD. Maternal CRP concentration was measured in archived serum collected during 15–19 weeks of pregnancy and genome-wide single-nucleotide polymorphism (SNP) data were generated. The levels of CRP were compared between ASD vs GP and DD vs GP. The genetic associations with CRP were assessed via linear regression. Maternal CRP levels in mid-pregnancy were lower in mothers of ASD compared with controls. The maternal CRP levels in the upper third and fourth quartiles were associated with a 45 and 44% decreased risk of ASD, respectively. Two SNPs at the CRP locus showed strong association with CRP levels but they were not associated with ASD. No difference was found between maternal CRP levels of DD and controls. The reasons for the lower levels of CRP in mothers of ASD are not known with certainty but may be related to alterations in the immune response to infectious agents. The biological mechanisms underlying this association remain to be clarified.

Serum C reactive Protein in Preeclamptic Women

The incidence of preeclampsia is high in the developing countries. Since this condition is preventable if detected and treated at an early stage, it is essential to diagnose the disease at an early stage, and to institute proper medical care on time. The present study carried out in the Department of Obstetrics and Gynaecology, BIRDEM, and Dhaka Medical College Hospital during January 2009 and June 2010, was aimed to find out concentration of serum C reactive protein (CRP) in preeclamptic women. The study included 60 pregnant women; 30 normal (control) and 30 preeclamptic (case) pregnant women in their third trimester. Estimation of CRP was done by immunoprecipitation assay turbulometry method for both groups. The mean (±SD) age was 23.23±4.58 (control) and 23.90±3.20 (case) years (no significant difference). However, BMI, SBP and DBP were significantly (P<0.001) high in case compared to control group (BMI: 23.37±1.47 and 21.81±1.45 kg/m2; SBP: 148.33±13.41 and 108.00±7.14 mmHg; DBP: 106.67±6.99 and 69.67±5.56 mmHg). C reactive protein concentration (mg/dl) was significantly higher (P<0.001) in case group (10.57±6.71) compared to control group (0.63±0.49). In control and case group, respectively, CRP was normal (£0.8 mg/dl) in 25 (83.3%) and 2 (6.7%), and raised (>0.8 mg/dl) in 5 (16.7%) and 28 (93.3) (P<0.001). This study shows that maternal CRP concentration tends to be significantly high in women with preeclampsia. DOI: http://dx.doi.org/10.3329/jbcps.v31i4.21003 J Bangladesh Coll Phys Surg 2013; 31: 194-198

Association of maternal folate nutrition and serum C-reactive protein concentrations with gestational age at delivery

C-reactive protein (CRP) is the most extensively studied inflammatory risk marker, and elevated serum CRP concentrations in pregnant women are known to be associated with subsequent development of preeclampsia and preterm delivery. Researchers have suggested that folate intake may help to control the inflammation process. We examined whether folate nutrition modifies the relationship between serum CRP concentration and gestational age at delivery. Serum CRP concentrations were analyzed in 815 pregnant women between 12 and 28 weeks of gestation. Dietary intakes were assessed using a 24-h dietary recall. The serum folate and high-sensitivity CRP concentrations were analyzed by radioassay and latex agglutination tests, respectively. Serum CRP concentration was negatively correlated (P < 0.001) with gestational age at delivery. Serum folate concentration was negatively correlated (P < 0.01) with serum CRP concentration, and total dietary folate intake was positively correlated (P < 0.001) with serum folate concentration. Multiple regression analysis after adjustment for covariates revealed that maternal CRP concentrations were negatively associated with gestational age at delivery; these negative associations existed only when folate intake during pregnancy was below the Korean estimated average requirements (520 μg dietary folate equivalent per day), and serum folate concentrations were above the normal (6 ng/ml). We found that adequate maternal folate intake during pregnancy may have a beneficial role against shorter gestational age at delivery, which is associated with higher serum CRP concentrations in pregnant women.

Maternal and fetal C-reactive protein genotype and first trimester CRP concentrations in maternal plasma

Maternal plasma CRP concentrations in pregnancy are increased over pre-pregnancy values and high concentrations have been associated with adverse obstetrical outcomes. The objective of this study was to explore the relationship between maternal and fetal variation in C-reactive protein (CRP) genotype and maternal plasma CRP concentrations in the first trimester in low risk patients. DNA was extracted from maternal and cord blood of subjects in a prospective observational cohort. Single-nucleotide polymorphism (SNP) selection was made using a linkage disequilibrium bin approach. CRP concentrations were measured in first trimester maternal plasma using an enzyme-linked immunosorbent assay (ELISA) kit. Kruskal–Wallis rank testing was used to analyze genetic and clinical determinants of CRP concentrations. Genotype results were available in 190 mother–baby pairs. There was no significant difference in CRP concentration among maternal or fetal CRP genotypes. Thus, first trimester concentrations of maternal plasma CRP in low risk subjects do not appear to be significantly associated with CRP genotype. Instead, differences in clinical factors probably have more influence on baseline maternal CRP concentrations.

C-reactive protein independently predicts HIV-related outcomes among women and children in a resource-poor setting

To evaluate C-reactive protein (CRP) as a predictor of HIV-related outcomes among women and children in a resource-poor setting. We measured serum CRP concentration among 606 HIV-infected women, all of whom were not taking highly-active antiretroviral therapy, 3 to 11 months after they gave birth, and assessed relationships of CRP to HIV-related endpoints, including maternal disease progression, mother-to-child transmission of HIV, and maternal and child mortality. We used Cox proportional hazards and regression models adjusted for age, sociodemographic characteristics, anthropometric measurements, hemoglobin, CD4 cell count, HIV viral load, and, for child outcomes, breastfeeding status. Ninety-four women had a high CRP concentration (> 10 mg/l). During the follow-up, 56 women progressed to WHO stage 4 and 188 died, and a high maternal CRP concentration was associated with a 2.26-fold [95% confidence interval (CI), 1.64-3.12] greater risk of progression to stage 4 or death. Among children, 174 acquired HIV and 116 died by age 2 years, and a high maternal CRP concentration was associated with a 3.03-fold (95% CI, 1.85-4.96) greater risk of child mortality. In multivariate analyses among adults, a high maternal CRP concentration was associated with a 1.55-fold (95% CI, 1.08-2.23) greater risk of progression to stage 4 or death. A maternal CRP concentration was not significantly associated with mother-to-child transmission of HIV. A high maternal CRP concentration independently predicts HIV disease progression, maternal mortality, and child mortality in a resource-poor setting. C-reactive protein may be an important and inexpensive prognostic indicator for HIV-infected women and their children.

Gestational diabetes mellitus is associated with increased C‐reactive protein concentrations in the third but not second trimester

Serum C-reactive protein (CRP) concentrations were measured longitudinally throughout pregnancy to test the hypothesis that CRP could relate more closely to glucose tolerance than to adiposity. The CRP concentrations in pregnant women with normal glucose tolerance (NGT) and those with gestational diabetes mellitus (GDM) were measured at the same time as the oral glucose tolerance test (OGTT), at the 24th and 28th weeks of gestation and between the 37th and 38th weeks of gestation. At the end of the third trimester, women with GDM had significantly higher CRP levels than women with NGT [median (interquartile range), 9.7 mg L(-1) (5.4-16.0) and 5.7 mg L(-1) (5.1-7.2); P < 0.001, respectively], but at the time of the diagnostic OGTT no significant difference between the two groups was observed. This was owing to a significant increase of CRP in women with GDM between the time of the OGTT and the 37th-38th gestational weeks [median (interquartile range), 1.9 mg L(-1) (-2.2, 6.7); P = 0.01]; whereas, no change in CRP was found in women with NGT [median (interquartile range), -0.1 mg L(-1) (-2.4, 3.1); P = 0.76]. Multiple linear regression analysis showed only a significant independent influence of GDM (P < 0.001) on maternal CRP concentrations in the 37th-38th gestational weeks and a significant influence of body mass index (P < 0.007), but no influence of GDM at the time of the OGTT. These data suggest that in women with gestational diabetes the CRP concentration is primarily related to the degree of adiposity until the second trimester and that thereafter impaired glucose metabolism appears to be the predominant predictor of changes in CRP.

Immune Markers in Pregnancy A Study on Neopterin, β2-Microglobulin, Deoxythymidine Kinase and C-Reactive Protein

Summary Neopterin and β2-microglobulin but neither C-reactive protein nor deoxythymidine kinase increased in maternal serum from pregnancy week 20 to 40. Only maternal C-reactive protein concentrations changed during vaginal delivery and after 4 days post partum. Retroplacental plasma levels of neopterin, deoxythymidine kinase and β2-microglobulin were significantly higher than in maternal peripheral serum which was interpreted as an indication of increased activity of the immune system as influenced by the fetoplacental unit. The concentrations of neopterin, deoxythymidine kinase and β2-microglobulin were significantly higher in mixed artero-venous umbilical plasma than in the retroplacental plasma, possibly reflecting activation signals to immunocompetent cells in the neonates. The possibility of a transfer of these compounds from fetal to maternal circulation was also pointed out.