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


METHODS
Prospective clinical study.


METHODS
Fetal medicine unit and neonatal intensive care unit, Antoine Beclere Hospital, Clamart, France.


METHODS
Thirty-one pregnancies complicated by chorioamnionitis leading to birth before 32 weeks of gestation.


METHODS
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.


METHODS
The occurrence of periventricular leukomalacia was assessed by transfontanellar ultrasound and magnetic resonance imaging.


RESULTS
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.


CONCLUSIONS
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.
Baud
O
O
Service de Réanimation et Pédiatrie Néonatales, University Antoine Béclère Hospital, Assistance Publique/Hôpitaux de Paris, Clamart, France.
Emilie
D
D
Pelletier
E
E
Lacaze-Masmonteil
T
T
Zupan
V
V
Fernandez
H
H
Dehan
M
M
Frydman
R
R
Ville
Y
Y
D000653:Amniotic Fluid / Q000737:chemistry*; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002821:Chorioamnionitis / Q000378:metabolism*; D016207:Cytokines / Q000032:analysis*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007375:Interleukin-1 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D007969:Leukomalacia, Periventricular / Q000378:metabolism; D007752:Obstetric Labor, Premature / Q000378:metabolism; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000378:metabolism*; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein