Maternal Serum C-reactive Protein Levels Research Articles

Association of C-reactive Protein in Preeclampsia

Introduction: Preeclampsia is a multisystemic disorder that complicate about 7-10 percent of human pregnancies.Worldwide this syndrome contributes high maternal and perinatal mortality and morbidity. C-reactive protein, a marker of tissue damage and inflammation, is elevated in seurm in overt preeclampsia. It is used as an objective and sensitive index of overall inflammatory activities in the body. Aims and Objectives: To explore the association of C-reactive protein level with the preeclampsia patients. Materials and Methods: The present study was a Case–Control study, conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of clinical pathology of Sir Salimullah Medical College Hospital, Mitford, Dhaka during the period of January 2013 to December 2013.The study population was pregnant women with preeclampsia and normal term pregnant patients admitted during study period. A total of 66 patients were included in the study. Among them 33 were clinically diagnosed preeclampsia women grouped as Cases and another 33 were age, parity and BMI matched term pregnant women as Controls. Eastmation of serum C-reactive protein was done by Nyco Card Reader-II method (Appendix-11). Statisticians analysis was perform by using SPSS. Results: C-reactive protein concentration (mg/L) was found significantly higher (p<0.001) in case group (17.93±10.5) than control group (7.45±1.80). Creactive protein was _ 6mg/L in 29(87.9%) in case group and 9 (27.3%) in control group and C-reactive protein values showed significant positive correlation with systolic and diastolic blood pressure (p<0.001) in case group. C-reactive protein concentration was found significantly higher (p<0.001) in severe preeclampsia group than mild preeclampsia group. Conclusion: Therefore, it can apparently be concluded from this study that increased maternal serum C-reactive protein level might be a strong risk factor for preeclampsia, although the precise role of C-reactive protein in this regard whether causal or consequential, is yet to be determined. Finding of this study might be helpful for formulating a guideline for management of pregnant women with preeclampsia. Medicine Today 2024, Vol.36 (2): 67-71

Semi-quantitative metalloproteinase-8 rapid test for the prediction of adverse pregnancy outcomes in patients with preterm premature rupture of membranes

ObjectiveWe aimed to determine whether the semi-quantitative metalloproteinase-8 (MMP-8) bedside test is a worthwhile indicator in reflecting the severity of of intra-amniotic inflammation (IAI) and in predicting adverse pregnancy outcomes. Study DesignThis retrospective cohort study comprised 76 singleton-pregnant women admitted to the Seoul National University Bundang Hospital with a diagnosis of preterm premature rupture of membranes (preterm PROM) between 20 weeks 0 days and 33 weeks 6 days of gestation who underwent trans-abdominal amniocentesis to confirm intra-amniotic infection by positive results for aerobic/anaerobic bacteria, fungi, and genital mycoplasma and evaluate lung maturity. The semi-quantitative MMP-8 rapid test kit employs a colourimetric assay to quantify MMP-8 levels in amniotic fluid (AF), expressing results from 0 to 100 percent. Participants were divided into three groups: group 1, including negative MMP-8 test with colour scale of 0 % (negative, n = 17); group 2, including positive MMP-8 test with colour scale < 51 % (weak positive, n = 21); and group 3, including positive MMP-8 test with colour scale of 51 %–100 % (strong positive, n = 38). ResultsApproximately 78 % (59/76) of the participants showed a positive MMP-8 test result; all culture-proven AF samples (33.3 % [25/75]) yielded positive MMP-8 test, categorizing these patients into either group 2 or group 3. A significant trend was observed where the rate of positive culture-proven samples increased with the progression from group 1 (negative) to group 3 (strong positive). Both white blood cell counts in AF and maternal serum C-reactive protein levels were found to escalate with the progression of test results from negative to strong positive. This progression was associated with an increased risk of spontaneous preterm birth within 48 h, 7 days, and 14 days from amniocentesis and within 34 weeks of gestation. ConclusionThe more the test results progress from negative to strong positive, the shorter the interval from amniocentesis to delivery becomes, and the higher the risk of intra-amniotic infection, spontaneous preterm delivery, and other perinatal complications. This relationship highlights the critical value of the semi-quantitative MMP-8 rapid test in predicting adverse pregnancy outcomes in patients with preterm PROM.

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.

Correlation between Group B Streptococcus Infection in The Vagina with Maternal Serum C-Reactive Protein Levels in Preterm Labor

For decades GBS has been the most common cause of early-onset of neonatal infection. Ascending route infection with Group B Streptococcus bacteria increases the risk of preterm premature rupture of membranes, fetus infection, sepsis, preterm birth, and meningitis in infants. C-Reactive Protein is a sensitive marker of systemic inflammation where an increase in CRP can also be triggered by GBS infection. Objective of this study is to determine the relationship between Group B Streptococcus infection in the vagina of pregnant women and maternal serum C-Reactive Protein levels in preterm labor. The design of this study was cross-sectional in the preterm delivery population. This study was conducted in the obstetrics delivery room at Sanglah Hospital from January 2021 to January 2022. A total of 31 samples met the inclusion criteria, each of which was examined for vaginal swab culture and maternal serum CRP levels. Vaginal swab samples were processed at the Microbiology Laboratory of Sanglah Hospital, Denpasar. Maternal serum CRP samples were processed at the Clinical Pathology Laboratory of Sanglah Hospital, Denpasar. Bivariate analysis using Chi-square test. The relationship between GBS infection and maternal serum CRP levels using the Prevalence Ratio. The growth of Streptococcus agalactiae from vaginal swab culture was 7 samples (22.58%). Positive GBS in the group of high maternal serum CRP levels were found in 6 patients (19.4%) and the group of low maternal serum CRP levels as many as 1 patient (3.2%) while negative GBS in the group of high maternal serum CRP levels were found in 5 patients (16.1%) and 19 patients (61.3%) in the group of low maternal serum CRP levels. The Prevalence Ratio value obtained was 4.1 (1.78-9.49, 95% CI; p = 0.002). There is a positive relationship between GBS infection and maternal CRP serum levels in preterm labor where positive GBS is a risk factor that increases maternal CRP serum levels in preterm labor.

Maternal serum levels of C-reactive protein at early pregnancy to predict fetal growth restriction and preterm delivery: A prospective cohort study.

BackgroundA considerable evidence suggests that maternal inflammation dysregulation may play as a risk factor for both maternal and neonatal outcomes. Objective: The study's objectives were designed to evaluate the correlation between serum C-reactive protein (CRP) levels, as an inflammation factor, preterm delivery, and small for gestational age (SGA) births.Materials and MethodsThis prospective cohort study was conducted on 120 singleton pregnant women with gestational age less than 20 wk. Maternal CRP serum concentration was measured before 20 wk gestation. Patients were followed-up until the delivery and final outcomes of pregnancy were recorded in terms of preterm delivery and SGA births. Results: Serum CRP levels in participants with normal fetuses and SGA births were 4.09 1.35 mg/l and 6.04 3.29 mg/l, respectively (p = 0.19), while in cases of preterm delivery, it was 9.63 5.78 mg/l (p 0.001). By using receiver operating characteristic (ROC) curve, serum CRP levels (cut-off point 5.27 mg/l, area 0.836) had acceptable diagnostic accuracy value in distinguishing preterm delivery (sensitivity (75%), specificity (86.1%), positive predictive value (37.5%), negative predictive value (96.87%), accuracy (85%)) and serum CRP levels (cut-off point 6.67 mg/l, area 0.673) in distinguishing SGA births (sensitivity (50%), specificity (91.2%), positive predictive value (23.07%), and negative predictive value (97.19%), and accuracy (89.16 %)).ConclusionHigher maternal serum CRP levels measured early in pregnancy may associate with higher risk of preterm delivery and SGA.

Elevated maternal serum C-reactive protein levels and neonatal infection in term pregnancy

Elevated maternal serum C-reactive protein levels and neonatal infection in term pregnancy

Relationship between C-reactive Protein and Screening Test Results of Gestational Diabetes in Pregnant Women Referred to Health Centers in Isfahan in 2013-2014.

Background:Gestational diabetes is the second common disorder in pregnancy period, which is detected in 24–28 weeks of gestational age through screening tests. Low-grade systematic inflammation is associated with an increased risk of type 2 diabetes. C–Reactive Protein (CRP), an acute phase protein produced by hepatocytes, may be associated with diabetes. This study aimed to investigate serum levels of CRP in women with Gestational Diabetes Mellitus (GDM) and impaired glucose tolerance test compared with control subjects.Materials and Methods:This observational longitudinal study was conducted on 176 pregnant women in Isfahan. After administration of a CRP test in these women in the first trimester, a screening test of Glucose Challenge Test (GCT) with 50-g oral glucose was conducted in 24–28 weeks of gestational age. Then, CRP levels and GCT were compared.Results:Serum CRP levels were not significantly correlated with positive GCT among the women. In GDM patients, there was not a significant correlation between CRP and BMI.Conclusions:There was no significant correlation between maternal serum CRP level and gestational diabetes. Maternal serum CRP level in the first trimester cannot predict Intolerance Glucose Test (IGT) in 26–30 weeks of gestational age.

C-reactive protein and white blood cell count as predictors of maternal and neonatal infections in prelabour rupture of membranes between 34 and 41 weeks of gestation

Prelabour rupture of the membranes (PLROM) is defined as rupture of membranes before the onset of labour. It is one of the most common clinical events, where pregnancy can turn into a high-risk situation for mother and foetus. As prevention of PLROM is difficult, one has to concentrate on management to reduce its complications. Accurate prediction of infection remains a main challenge in cases of PLROM. We conducted a prospective study of all women admitted for PLROM at or after 34–41 weeks of gestation to investigate the predictive value of C-reactive protein (CRP) and white blood cell (WBC) count for early-onset neonatal infection (EONI) and maternal chorioamnionitis. The analysis was done by comparing areas under ROC curves and sensitivity. Lowest best cut off of maternal serum CRP level >4.9 mg/l and lowest cut off of WBC count 12,450/cumm have good predictive values for maternal chorioamnionitis and EONI.Impact statementWhat is already known on this subject? The ability to detect chorioamnionitis and predict neonatal infection at an early stage would be helpful in its treatment and would make it possible to prolong the pregnancy.What do the results of this study add? Maternal serum CRP level and WBC count obtained at admission are predictors of chorioamnionitis and EONI although WBC count alone is not a good indicator of them. A lowest best cut off of serum CRP level >4.9 mg/l and lowest cut off of WBC count 12,450/cumm have good predictive values for maternal chorioamnionitis and EON.What are the implications of these findings for clinical practice and/or further research? We propose that maternal serum CRP level and WBC count should be used as screening test for EONI and chorioamnionitis rather than a diagnostic test.

The prevalence of abnormal vaginal flora and predictive factors for intrauterine infection in pregnant Korean women with preterm labor

To investigate the prevalence of abnormal vaginal flora (AVF) and predictive factors for intrauterine infection in pregnant Korean women with preterm labor. The authors reviewed the medical records of 106 pregnant Korean women with preterm labor admitted to Eulji Medical Center between January 2006 and August 2011. The results of vaginal discharge tests and maternal serum C-reactive protein (CRP) level at admission, placental biopsy, and perinatal outcomes were searched. The prevalence of abnormal vaginal flora was calculated. The perinatal outcomes and predictive factors for intrauterine infections were analyzed based on placental pathology and early-onset neonatal sepsis. The prevalence of abnormal vaginal flora was 75.4%. Ureaplasma urealyticunz (UU), intermediate flora, Candidiasis, bacterial vaginosis, and aerobic bacterial colonization were detected in 40.6%, 38.7%, 17%, 14.2%, and 11.3% of the women, respectively. The frequency of early-onset neonatal sepsis was significantly different between women with aerobic bacterial colonization and those with normal flora (p = 0.008). An elevated maternal serum CRP level was an independent intrauterine infection predictor (odds ratio, 1.918; 95% confidence interval, 1.102-3.338; p = 0.048). Aerobic bacterial colonization may predict early-onset neonatal sepsis. An elevated maternal serum CRP level was an independent intrauterine infection predictor based on placental infections and early-onset neonatal sepsis.

Maternal c-reactive protein and oxidative stress markers as predictors of delivery latency in patients experiencing preterm premature rupture of membranes.

To evaluate the usefulness of maternal serum c-reactive protein (CRP), lipid peroxide, and oxygen radical absorbance capacity (ORAC), to predict the interval between membrane rupture and delivery in patients with preterm premature rupture of membranes (PPROM). The present prospective study included patients with singleton pregnancies experiencing PPROM at earlier than 34weeks of pregnancy who underwent spontaneous vaginal delivery between August 1, 2010 and July 31, 2013 at Chonnam National University Hospital, Republic of Korea. Patients were categorized based on whether delivery occurred within 3days of PPROM or after. CRP levels, lipid peroxide (using malondialdehyde levels), ORAC, protein carbonyl, and other potential risk factors were compared between the groups. There were 72 patients included. Maternal serum CRP levels, malondialdehyde levels, and Bishop Score were higher in patients who underwent delivery within 3days (all P<0.05); ORAC levels were lower among these patients (P=0.002). A receiver operating characteristic curve analysis showed that CRP, malondialdehyde, and ORAC levels were predictive of delivery within 3days after PPROM. Maternal serum CRP, malondialdehyde, and ORAC levels at admission were useful in predicting the latent period in patients with PPROM.

Prediction of preterm delivery by second trimester inflammatory biomarkers in the amniotic fluid

ObjectiveTo search for a correlation between mid-pregnancy altered levels of inflammatory markers and preterm delivery. MethodsA prospective cohort series included 39 patients undergoing amniocentesis one additional milliliter of amniotic fluid (AF) was stored for later dosage of interleukin-6 (Il-6), matrix metalloproteinase-9 (MMP-9), glucose and C-reactive protein (CRP). Maternal serum CRP and glucose levels were also obtained. Exclusion criteria were multiple pregnancies, chorioamnionitis, group B streptococcus colonization, bacterial vaginosis and cases with proven aneuploidy. We searched for correlation between AF and plasmatic markers and also for a difference between patients with term and preterm delivery. Results33 participants were eligible and one third had preterm delivery. Levels of the plasmatic biomarkers did not correlate with the AF biomarkers except for plasmatic glucose and AF IL-6 levels (r=0.350; p=0.016). The levels of all AF biomarkers did not differ significantly between the pre-term and the term groups (p>0.05). The optimal screening cutoffs for identifying pregnancies at risk were different than the ones initially indicated. ConclusionMid-pregnancy amniotic fluid biomarker levels do not correlate with preterm delivery. Plasma CRP is not correlated with these markers. Cutoff levels suggested are sparse and heterogeneous. Larger studies are needed before advising routine measurement of these markers.

Usefulness of maternal serum C-reactive protein with vaginal Ureaplasma urealyticum as a marker for prediction of imminent preterm delivery and chorioamnionitis in patients with preterm labor or preterm premature rupture of membranes.

To assess whether maternal serum C-reactive protein (CRP) and genital mycoplasmas measured can help predict imminent preterm delivery or chorioamnionitis in patients with preterm labor (PL) or preterm premature rupture of membranes (PPROM). The study group consisted of 165 women with PL or PPROM. Vaginal cultures for genital mycoplasmas and maternal blood for CRP were obtained when they were admitted for the management of PL or PPROM. An elevated level of serum CRP was defined as ≥0.8 mg/dL. Histologic evaluation of the placenta was performed after delivery. The prevalence of positive vaginal fluid cultures for Ureaplasma urealyticum (UU) was 63.0%, and elevated maternal serum CRP was 32.7%. No outcome variables were associated with vaginal UU infection in patients with lower CRP levels. However, among women with elevated CRP, the mean gestational age at birth was significantly reduced, and low Apgar score, neonatal intensive care unit admission, histologic chorioamnionitis, and delivery within 7 days of admission were significantly more common in patients with vaginal UU. Although vaginal UU in PL or PPROM cannot act as the sole predictor of imminent preterm delivery or chorioamnionitis, it can provide predictive information in patients with elevated maternal serum CRP levels.

Abstract P096: Maternal Serum C-Reactive Protein Levels During Pregnancy and Risk for High C-Reactive Protein 7-13 Years Later

Introduction: Elevated serum C-reactive protein (CRP) can be a marker of disease activity involving inflammation, such as pregnancy complications and cardiovascular disease (CVD). Systemically high levels of CRP in women, including during pregnancy, may indicate higher risk for CVD. It is unknown if CRP measured during the pro-inflammatory state of pregnancy correlates with concentrations assessed 7-13 years after delivery. Hypothesis: Concentrations of CRP assessed during pregnancy will be related to CRP measured several years after pregnancy, independent of weight gain. Methods: We studied the first 252 women enrolled in the follow-up of the Pregnancy Outcomes and Community Health Study (POUCHmoms 2011-2013) with complete CRP data for the pregnancy (mean gestational age: 22.36 [2.22] weeks) and POUCHmoms visits (mean follow-up: 10.76 [1.38] years). The relative risk for high hsCRP (≥ 3.39 μg/ml) at the follow-up visit, related to quartiles of CRP during pregnancy, was examined using stepwise regression models. Results: Median (IQR) levels of pregnancy CRP and hsCRP at the follow-up visit were 5.68 [3.08, 9.76] and 3.39 [0.69, 9.73] μg/ml, respectively. Although absolute values of hsCRP at follow-up were generally lower than pregnancy CRP, 56% of women in the top and bottom quartiles of pregnancy CRP (71 of 126) were in the same quartile for hsCRP at follow-up (figure). The relative risk of having high hsCRP (≥ 3.39 μg/ml) at follow-up ranged from 2.7-5.2 for the 2 nd - 4 th quartiles of pregnancy CRP (vs. the 1st quartile). Controlling for pre-pregnancy BMI and follow-up weight change, the relative risk of having high hsCRP at follow-up was significantly higher for the 2 nd (1.15 [1.02-1.30]),3 rd (1.19 [1.05-1.35), and 4 th (1.22 [1.05-1.41]) quartiles of pregnancy CRP. Conclusions: Pregnancy CRP levels are related to hsCRP levels several years later in this cohort of women, even after adjusting for pre-pregnancy BMI and follow-up weight change. CRP assessed in pregnancy may reflect inflammatory status later in life.

Can maternal serum C-reactive protein levels predict successful labour induction with intravenous oxytocin in term pregnancies complicated with premature rupture of the membranes? A cross-sectional study.

High sensitive C-reactive protein (hs-CRP) is a serum marker for acute inflammation and/or infection. The diagnostic value of serum levels of this protein has been investigated among patients with preterm delivery, premature rupture of the membranes (PROM) and preeclampsia. In this study, the predictive value of hs-CRP for successful labour induction in patients with PROM has been evaluated. Eighty-six term pregnant patients who experienced pre-labour amniotic membrane rupture from 37-41 weeks of gestation were selected for the study. Maternal serum hs-CRP levels were determined upon admission to the delivery unit and low dose intravenous oxytocin infusion was started to induce labour. The mode of delivery and time interval from labour induction to delivery were the primary endpoints of the study. Twenty-five (29%) out of 86 patients had delivered by caesarean section, while the remaining 61 (71%) had delivered vaginally. The receiver operator characteristic (ROC) curve for testing the significance of higher hs-CRP values and lower probability of vaginal delivery revealed that higher hs-CRP values were found to be insignificant for predicting the need for caesarean section. No statistically significant correlation between high serum hs-CRP levels and the probability of caesarean delivery has been established (Spearman rho:-.126; p=0.24). The mean maternal serum hs-CRP levels during PROM were found to be similar between vaginal and abdominal deliveries. Hs-CRP, as an inflammatory marker, was found to be neither specific nor sensitive for the prediction of successful labour induction in term pregnancies with pre-labour rupture of the membranes.

Maternal C-Reactive Protein at Hospital Admission Is a Simple Predictor of Funisitis in Preterm Premature Rupture of Membranes

Aim: To analyze the prognostic value of maternal serum C-reactive protein (CRP) in predicting funisitis in patients with preterm premature rupture of membranes (pPROM). Methods: 66 patients (gestational age 24–33 weeks) hospitalized 1–12 h after pPROM were enrolled. White blood cell count (WBC), platelet count (PLT) and plasma concentration of CRP were assessed every 3 days. Histological evidence of chorioamnionitis and funisitis was obtained post-partum. Receiver operating characteristic (ROC) curves were employed to evaluate the role of maternal CRP in predicting funisitis. Results: Funisitis was found in 24 patients (36.3%); 42 patients (63.7%) without funisitis were considered as controls. PLT and WBC at admission and before delivery did not show significant differences and were not statistically different between the two groups. Patients with funisitis had significantly higher CRP levels both at admission to hospital and 24– 48 h before delivery. ROC curve analysis showed that CRP at admission (area under the curve: 0.671, p = 0.021) and before delivery (area under the curve: 0.737, p = 0.001) are predictive of funisitis. Conclusions: High maternal serum CRP levels (>20,000 µg/l) in pPROM patients at admission to hospital may be an early marker which indicates, with a good diagnostic performance, the presence of funisitis.

Maternal serum C‐reactive protein in early pregnancy and occurrence of preterm premature rupture of membranes and preterm birth

The aim of this study was to determine the relationship between maternal serum C-reactive protein (CRP) levels in the first 20 weeks of pregnancy and later occurrence of preterm premature rupture of membranes and preterm birth. A prospective cohort study that measured maternal serum CRP levels in 778 pregnant women in the first half of pregnancy was performed in the city of Noor (north Iran), and included follow-up of patients up to time of delivery. Preterm premature rupture of membranes and preterm birth were defined as the occurrence of membranes rupture and birth, respectively before 37 weeks of gestation. Of the 778 pregnancies studied, 19 (2.41%) preterm premature rupture of membranes and 58 (7.3%) preterm births were seen. Median CRP levels in preterm premature rupture of membranes and preterm birth cases were much higher than in term deliveries (7 and 6.8 respectively vs 2.4 mg/L; 66.67 and 64.76, respectively vs 24.38 nmol/L). CRP levels >4 mg/L had statistically significant relationships with preterm premature rupture of membranes (OR 5.91, 95% CI 2.07-16.89) and preterm birth (OR 8.95, 95% CI 4.60-17.43). With a cut-off level of 4 mg/L of CRP, sensitivity, specificity, and likelihood ratios (LR(+) and LR(-) ) for preterm birth were 81, 70, 2.70, 0.28%, respectively, and for preterm premature rupture of membranes they were 79, 67, 2.41 and 0.31%, respectively. It seems that the inflammatory marker, CRP, can be used in the early stages of pregnancy to identify women at risk of experiencing preterm premature rupture of membranes and preterm birth.

Relationship between Maternal Serum C-Reactive Protein, Funisitis and Early-Onset Neonatal Sepsis

The aim of this study was to determine whether maternal serum C-reactive protein (CRP) is of value in predicting funisitis and early-onset neonatal sepsis (EONS) in women with preterm labor or preterm premature rupture of membranes (PROM). This retrospective cohort study included 306 consecutive women with preterm labor or preterm PROM who delivered preterm singleton neonates (23-35 weeks gestation) within 72 hr of CRP measurement. The CRP level was measured with a highly sensitive immunoassay. The sensitivity, specificity, positive predictive value, and negative predictive value of an elevated serum CRP level (≥ 8 mg/L) were 74.1%, 67.5%, 32.8%, and 92.4% for funisitis, and 67.7%, 63.3%, 17.2%, and 94.6% for EONS, respectively. Logistic regression analysis demonstrated that elevated levels of serum CRP were significantly associated with funisitis and EONS, even after adjusting gestational age. The maternal serum CRP level obtained up to 72 hr before delivery is an independent predictor of funisitis and EONS in women with preterm labor or preterm PROM. A low serum CRP level (< 8 mg/L) has good negative predictive value in excluding funisitis and EONS, and may therefore be used as a non-invasive adjunct to clinical judgment to identify low-risk patients.

Maternal C-reactive protein levels in pregnancy are associated with wheezing and lower respiratory tract infections in the offspring

We assessed whether maternal C-reactive protein (CRP) levels during pregnancy and CRP gene variations are associated with wheezing and lower respiratory tract infections (LRTIs) in offspring. Information on wheezing and LRTIs in the offspring at 6 and 14 months of age, and maternal CRP levels and genotype was obtained from a population-based birth cohort. A total of 63 children (12.5%) experienced recurrent wheezing and 61 (12.4%) a recurrent diagnosis of LRTIs. Children in the highest tertile of maternal CRP levels had a higher risk of experiencing recurrent wheezing (adjusted odds ratio, 2.87; 95% confidence interval, 1.23-6.71) and being diagnosed with recurrent LRTIs (odds ratio, 2.37; 95% confidence interval, 1.01-5.55), as compared with children in the lowest tertile. The rs1205 polymorphism influenced maternal serum CRP levels but not the risk of the offspring outcomes. Higher CRP levels in pregnancy are associated with wheezing and LRTIs in offspring. However, genetic variation in CRP influencing maternal levels is not related to these phenotypes.

Folate status, serum C‐reactive protein level and gestational age: Mothers and Children′s Environmental Health (MOCEH)

Folate deficiency and elevated serum C‐reactive protein (CRP) levels in pregnant women are independently known to be associated with adverse pregnancy outcomes, however, limited studies have been reported. This study was to investigate the relation between folate nutrition and elevated CRP level during pregnancy and their associations with birth outcome in 883 pregnant women of 12–28 weeks of gestation. Serum folate and CRP levels were analyzed by the radioimmunoassay and latex agglutination test, respectively. Maternal serum folate levels at mid‐pregnancy were positively correlated with dietary folate intake at mid‐pregnancy (p&lt;0.05). Maternal serum CRP levels at mid‐ (p&lt;0.05) and late‐pregnancy (p&lt;0.01) were negatively correlated with serum folate levels at each time of pregnancy, respectively. Multiple regression analysis with covariates revealed that the maternal CRP levels at mid‐ and late‐pregnancy were negatively associated with the gestational age. Further studies are warranted to explore the mechanisms underlying the associations between folate nutrition and CRP levels during pregnancy, and adverse pregnancy outcome.Supported by the Ministry of Environment and the 2nd stage of Brain Korea 21 project in 2009.

Association of Maternal Serum CRP, IL-6, TNF-α, Homocysteine, Folic Acid and Vitamin B12 Levels with the Severity of Preeclampsia and Fetal Birth Weight

Objective: To assess the levels and clinical significance of high sensitive(hs)-CRP (C‐reactive protein), IL-6(interleukin-6), TNF-α(tumor necrosis factor-α), homocysteine, folic acid and vitamin B12 in normotensive healthy pregnant women, mild and severe preeclamptic patients, and to evaluate the correlations between these markers and the severity of preeclampsia and fetal birth weight. Study design: Using a cross-sectional study design, hs-CRP, IL-6, TNF-α, homocysteine and vitamin B12 were measured in the third trimester of pregnancy from normotensive healthy women with uncomplicated pregnancies (n = 62), mild (n = 61) and severe (n = 60) preeclamptic patients. Results: There were statistically significant differences between three groups for hs-CRP (p = 0.012), TNF- α (p = 0.046), IL-6 (p = 0.015), homocysteine (p < 0.001) and fetal birth weight (p < 0.001). Fetal birth weights in mild (2477 ± 746) and severe (2435 ± 768) preeclamptic patients were significantly lower than controls (3485 ± 365) (p < 0.001). No significant difference was found between the three groups for folic acid (p = 0.066) and vitamin B12 (p = 0.286). Bonferroni adjusted multiple comparison test showed that the statistical differences with respect to TNF-α, IL-6 and homocysteine were mainly created by control and severe preeclampsia groups. Hs-CRP levels still remained higher in severe preeclampsia patients than mild preeclampsia and normotensive patients except for overweight patients in the previous two groups after Bonferroni post hoc adjustment test. Conclusion: Elevated maternal serum levels of hs-CRP, TNF- α, IL-6 and homocysteine in preeclamptic women correlate with fetal birth weight in the early third trimester.