Maternal Serum C-reactive Protein Concentrations Research Articles

Maternal serum C-reactive protein concentration and intra-amniotic inflammation in women with preterm prelabor rupture of membranes.

ObjectiveTo evaluate maternal serum C-reactive protein (CRP) concentrations in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) in relation to the presence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI).MethodsTwo hundred and eighty-seven women with singleton pregnancies complicated by PPROM between 2014 and 2016 were included in this study. Maternal blood and amniotic fluid samples were collected at the time of admission. Maternal serum CRP concentration was measured using a high-sensitivity immunoturbidimetric assay. Interleukin-6 (IL-6) concentration was measured using a point-of-care test. MIAC was diagnosed based on a positive polymerase chain reaction result for Ureaplasma species, Mycoplasma hominis, and/or Chlamydia trachomatis and for the 16S rRNA gene. IAI was characterized by an amniotic fluid IL-6 concentration of ≥ 745 pg/mL.ResultWomen with MIAC and IAI had higher maternal serum CRP concentrations than did women without (with MIAC: median 6.9 mg/L vs. without MIAC: median 4.9 mg/L; p = 0.02; with IAI: median 8.6 mg/L vs. without IAI: median 4.7 mg/L; p < 0.0001). When women were split into four subgroups based on the presence of MIAC and/or IAI, women with the presence of both MIAC and IAI had higher maternal serum CRP than did women with IAI alone, with MIAC alone, and women without MIAC and IAI (both MIAC and IAI: median: 13.1 mg/L; IAI alone: 6.0 mg/L; MIAC alone: 3.9 mg/L; and without MIAC and IAI: median 4.8 mg/L; p < 0.0001). The maternal serum CRP cutoff value of 17.5 mg/L was the best level to identify the presence of both MIAC and IAI, with sensitivity of 47%, specificity of 96%, positive predictive value of 42%, negative predictive value of 96%, and the positive likelihood ratio of 10.9.ConclusionThe presence of both MIAC and IAI was associated with the highest maternal serum CRP concentrations. Maternal serum CRP concentration in women with PPROM at the time of admission can rule out the presence of the combined condition of both MIAC and IAI, therefore, it may serve as a non-invasive screening tool to distinguish between women with PPROM who are at high or at low risk for the presence of both MIAC and IAI.

Levels of multiple proteins in gingival crevicular fluid and intra-amniotic complications in women with preterm prelabor rupture of membranes

Objective: The primary aim of this study was to identify the association between the local inflammatory response in gingival crevicular fluid measured by the levels of multiple proteins and maternal and intra-amniotic inflammatory responses measured by maternal serum C-reactive protein (CRP) and amniotic fluid interleukin (IL)-6 concentrations, respectively, in women with preterm prelabor rupture of membranes (PPROM).Methods: A prospective study was performed in which 78 women with singleton pregnancies complicated by PPROM between 24 + 0 and 36 + 6 weeks of gestation were included. Transabdominal amniocenteses were performed at the time of admission. A bedside assessment of amniotic fluid IL-6 was performed. Maternal serum CRP concentration was also measured at the time of admission. Gingival crevicular fluid was collected from the pocket of the selected tooth (the tooth with the deepest pocket) using standard sterile paper strips within 72 h after admission. Twenty-six proteins in the gingival crevicular fluid were assessed by multiplex the Meso-Scale technology.Results: No correlations between the levels of proteins in the gingival crevicular fluid and maternal serum CRP and amniotic fluid IL-6 concentrations were found, except for a weak positive correlation between granulocyte macrophage colony-stimulating factor and CRP.Conclusions: The local inflammatory response in the gingival crevicular fluid is not related to the maternal and intra-amniotic inflammatory responses in women with PPROM.

Correlation between maternal serum C-reactive protein concentrations and the degree of pre-eclampsia.

Introduction: Hypertensive disorders complicating pregnancy are common& form one of the deadly triadalong with hemorrhage and infection that contribute greatly to maternal morbidity & mortality. This disorder complicates about 5-7% of pregnancy worldwide.Aim of this study was to measure the levels of maternal serum C-reactive protein in pre-eclamptic and eclamptic patients at 28, 32 and 36 weeks of gestation and to find out any possible correlation between these levels and the severity of pre-eclampsia and eclampsia compared with normal values of control groupMethods: The study will be conducted on eighty primigravida at 28, 32, and 36 weeks of gestation attending El-Shatby maternity university hospital. They will be classified equally into the following groups: Group 1: (20 cases) Twenty normal pregnant women their blood pressure recorded as SBP 130 mmHg or less and DBP is 80 mmHg or less. These patients had no proteinuria, taken as a control group .Group 2: (20 cases) Twenty cases with mild pre-eclampsia, their blood pressure recorded as systolic blood pressure (SBP) more than or equal 140 mmHg and less than 160 mmHg. Their diastolic blood pressure (DBP) more than or equal 90 mmHg and less than 110 mmHg together with proteinuria which is 1+ or 2+ developed after 20 weeks of gestation. Group 3: (20 cases) Twenty cases with severe pre-eclampsia, recorded their blood pressure as SBP more than or equal 160 mmHg and DBP greater than or equal 110 mmHg recorded at least two occasions at least six hours apart plus proteinuria which is 3+ or 4+ on urine dipstick. Group 4: (20 cases) Twenty cases with antepartum eclampsia, these are pre-eclamptic patients with eclamptic fits characterized by generalized tonic-clonic convulsions. The cases should fulfill the following criteria: Primigravida, Singleton intrauterine pregnancy and Festational age 28, 32 and 36 weeks. Exclusion criteria: Hypertension, Increased C-reactive protein (infections, inflammatory conditions, malignancy) and Medical disorders (diabetes mellitus, hepatic disorders, renal disorders).Fits should be excluded when patients for group 4 were selected.Results and conclusions: The serum levels of C-reactive protein were positively correlated with pregnancy duration in pre-eclamptic pregnancy but not in normal pregnancy during the follow up period. As in normal pregnancy, there was a normal drop in the values of C-reactive protein at 32 weeks. The values of C-reactive protein at 28 weeks were 3.19±1.06 mg/L and the levels at 32 weeks were 2.70±1.01 mg/L then the levels raised up again at 36 weeks to be 4.01±1.28 mg/L. This normal drop was lost in pre-eclamptic pregnancy, as there was progressive increase in the values of C-reactive protein longitudinally during 28 weeks, 32 weeks and 36 weeks. The results were positively correlated with the severity of pre-eclampsia as shown in table 7. As C-reactive protein values in mildpre-eclampsia were much higher than values in normal pregnancy.

Maternal Serum C-Reactive Protein in Women with Preterm Prelabor Rupture of Membranes

ObjectiveThis study evaluated maternal C-reactive protein (CRP) as a predictor of microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA) in women with preterm prelabor rupture of the membranes (PPROM) before and after 32 weeks of gestation.MethodsThis study was a prospective observational cohort study of 386 women. Maternal serum CRP concentrations were evaluated, and amniotic fluid samples were obtained via transabdominal amniocentesis at the time of admission. Placentas underwent histopathological examination after delivery. MIAC was defined based on a positive PCR for Ureaplasma species, Mycoplasma hominis and Chlamydia trachomatis and/or positive 16S rRNA gene amplification. HCA was defined based on the Salafia classification.ResultsMaternal CRP was significantly higher in women with MIAC and HCA (median 9.0 mg/l) than in women with HCA alone (median 6.9 mg/l), MIAC alone (median 7.4 mg/l) and without MIAC or HCA (median 4.5 mg/l) (p<0.0001). CRP was a weak predictor of the occurrence of MIAC and HCA before and after 32 weeks of gestation. Only the 95th percentile of CRP and PPROM before 32 weeks exhibited a false-positive rate of 1%, a positive predictive value of 90% and a positive likelihood ratio of 13.2 to predict MIAC and HCA. However, the low sensitivity of 15% limits the clinical utility of this detection.ConclusionCRP is a poor predictor of the occurrence of MIAC and HCA, even at early gestational ages.

Maternal serum C-reactive protein concentrations in early pregnancy and subsequent risk of preterm delivery

Objective: To examine the relation between maternal early pregnancy serum C-reactive protein (CRP) and preterm delivery (PTD). Design and methods: Women were recruited before 20 weeks gestation and were followed up until delivery. Maternal serum CRP was measured by competitive immunoassay. Logistic regression procedures were used to calculate adjusted odds ratio (OR) and 95% confidence intervals (95%CI). Results: Elevations in CRP concentrations were associated with the risk of PTD overall. After adjusting for confounding, the OR for highest quartile (≥ 7.5 vs. < 2.0 mg/L) of CRP was 2.04 (95%CI: 1.13–3.69). Stratified analyses indicated that elevated CRP was associated with an increased risk of spontaneous preterm labour (OR = 2.15, 95%CI: 0.85–5.42), medically indicated preterm delivery (OR = 3.29, 95%CI: 0.98–11.02), and very preterm delivery (OR = 20.6, 95%CI: 2.53–168.03), but not with preterm premature rupture of membranes (OR = 1.48, 95%CI: 0.56–3.86). Conclusions: Elevated CRP concentrations in early pregnancy are associated with an increased risk of PTD, particularly medically indicated PTD and very PTD.

A prospective study of maternal serum C-reactive protein concentrations and risk of preeclampsia

Background We measured C-reactive protein (CRP), a clinical marker of systemic inflammation, in maternal serum collected at 13 weeks gestation on average, to determine whether elevations precede the clinical manifestation of preeclampsia. Methods Using a prospective, nested, case-control study design we measured CRP concentrations using a competitive immunoassay in 60 women who developed preeclampsia and in 506 women who remained normotensive throughout pregnancy. Logistic regression procedures were used to calculate odds ratio (OR) and 95% CI. Because maternal serum CRP is highly correlated with maternal prepregnancy body mass index (BMI), all analyses were repeated after stratification by maternal prepregnancy overweight status (BMI <25 v ≥25 kg/m 2). Results Overall, the risk of preeclampsia increased across successively higher tertiles of CRP (OR = 1.0, 1.6, and 3.5, with the lowest tertile as the referent group; P < .001 for trend). After adjusting for parity and first-degree family history of chronic hypertension, the OR in the highest tertile was 3.2 (95% CI = 1.5 to 6.7). Further adjustment for BMI greatly attenuated this association (OR = 1.8, 95% CI = 0.8 to 4.1). Elevated CRP concentrations (≥4.9 mg/L) were associated with a 2.5-fold increased risk of preeclampsia (95% CI = 1.1 to 5.5) in lean women. No similar association was observed among overweight women. Conclusions Elevated CRP is highly correlated with prepregnancy adiposity and appears to be an independent predictor of preeclampsia in lean women. Further work is needed to identify modifiable risk factors for systemic inflammation in early pregnancy and to explore further the extent to which CRP and prepregnancy adiposity independently and jointly contribute to preeclampsia risk.

Amniotic fluid concentrations of interleukin-1beta, interleukin-6 and TNF-alpha in chorioamnionitis before 32 weeks of gestation: histological associations and neonatal outcome.

To test the association between cytokine levels in the amniotic fluid and (i) the vascular invasion phase of intrauterine infection, (ii) the occurrence of periventricular leukomalacia; to assess the correlation between C-reactive protein levels, a recognised biological marker of inflammation in maternal serum and cytokine levels in the amniotic fluid. Prospective clinical study. Fetal medicine unit and neonatal intensive care unit, Antoine Beclere Hospital, Clamart, France. Thirty-one pregnancies complicated by chorioamnionitis leading to birth before 32 weeks of gestation. Interleukin 1-beta, Interleukin 6 and TNF-alpha prospectively measured in the amniotic fluid. Histological examination of the placenta. Ultrasound examination and magnetic resonance imaging of the brains of the newborn infants performed within the first week of life. The occurrence of periventricular leukomalacia was assessed by transfontanellar ultrasound and magnetic resonance imaging. There was a significant positive correlation between the occurrence of histological chorioamnionitis, vascular extension of infection of the membranes, maternal inflammatory syndrome and neonatal sepsis. A strong association was found between maternal serum C-reactive protein concentrations and cytokine levels in the amniotic fluid. Interleukin-1beta was the best predictor of vascular extension of chorioamnionitis, and TNF-alpha was the best predictor of the development of severe early neonatal infection. There was no association between the amniotic fluid levels of cytokines and the development of periventricular leukomalacia. These data suggest that IL-1beta, IL-6 and TNF-alpha are produced in relation to intrauterine inflammation and infection, but cannot be directly implicated in the development of fetal cerebral white matter lesions.