title: An elevated amniotic fluid matrix metalloproteinase-8 level at the time of mid-trimester genetic amniocentesis is a risk factor for spontaneous preterm delivery.
abstract: OBJECTIVE
  Strong evidence implicates chronic intra-amniotic inflammation in the etiology of mid-trimester abortion and spontaneous preterm delivery. The purpose of this study was to determine if concentrations of amniotic fluid matrix metalloproteinase-8, and cytokines such as interleukin-6 and angiogenin can identify patients at risk for spontaneous preterm delivery in patients undergoing mid-trimester amniocentesis.
  
  
  METHODS
  A case-control study was conducted to compare mid-trimester concentrations of amniotic fluid matrix metalloproteinase-8, interleukin-6, and angiogenin in patients who delivered at term and in those who delivered before term. The study included 19 cases with spontaneous preterm delivery and 95 matched controls with normal outcomes. Patients with abnormal fetal karyotypes or major anomalies were excluded. Matrix metalloproteinase-8, interleukin-6, and angiogenin were measured by using specific immunoassays. Mann-Whitney U tests, Fisher exact tests, and receiver-operating characteristic curves were used for statistical analysis.
  
  
  RESULTS
  The median amniotic fluid matrix metalloproteinase-8, interleukin-6, and angiogenin concentrations of patients with spontaneous preterm delivery were significantly higher than those of control cases (matrix metalloproteinase-8: median, 3.1 ng/mL [range, 0.3-1954.9 ng/mL] vs median, 1.3 ng/mL [range, <0.3-45.2 ng/mL], P <.01; interleukin-6: median, 0.32 ng/mL [range, 0.04-2.52 ng/mL] vs median, 0.18 ng/mL [range, 0.01-1.81 ng/mL], P <.01; angiogenin: median, 11.1 ng/mL [range, 4.5-30.7 ng/mL] vs median, 6.7 ng/mL [range, 1.3-21.9 ng/mL], P <.001). Amniotic fluid matrix metalloproteinase-8 concentrations higher than 23 ng/mL had the highest specificity and odds ratio (sensitivity, 42% [8/19]; specificity, 99% [94/95]; OR, 68.4 [95% CI, 7.8-599.1]) in the identification of the patients with preterm delivery after genetic amniocentesis.
  
  
  CONCLUSIONS
  Elevated mid-trimester concentrations of amniotic fluid matrix metalloproteinase-8, interleukin-6, and angiogenin are a risk factor for early spontaneous preterm delivery (<32 weeks). An elevated matrix metalloproteinase-8 level of >23 ng/mL is a powerful predictor of spontaneous preterm delivery (<32 weeks) with an odds ratio of 68.4. Amniotic fluid studies can be used to improve the risk assessment for preterm delivery in women who undergo mid-trimester amniocentesis for genetic indications.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Korea.
authors.forename: B H
authors.initials: BH
authors.lastname: Yoon
authors.forename: S Y
authors.initials: SY
authors.lastname: Oh
authors.forename: R
authors.initials: R
authors.lastname: Romero
authors.forename: S S
authors.initials: SS
authors.lastname: Shim
authors.forename: S Y
authors.initials: SY
authors.lastname: Han
authors.forename: J S
authors.initials: JS
authors.lastname: Park
authors.forename: J K
authors.initials: JK
authors.lastname: Jun
mesh_terms: D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000201:enzymology* / Q000382:microbiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D020784:Matrix Metalloproteinase 8 / Q000378:metabolism*; D007752:Obstetric Labor, Premature / Q000209:etiology*; D016017:Odds Ratio; D009994:Osmolar Concentration; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012259:Ribonuclease, Pancreatic / Q000378:metabolism; D012307:Risk Factors; D016990:Ureaplasma urealyticum / Q000302:isolation & purification
chemical_list: D015850:Interleukin-6; C046366:angiogenin; D012259:Ribonuclease, Pancreatic; D020784:Matrix Metalloproteinase 8