title: Decreased cervical proinflammatory cytokines permit subsequent upper genital tract infection during pregnancy.
abstract: OBJECTIVE
  The purpose of this study was to test the hypothesis that suppressed immune function in the lower genital tract, as represented by decreased concentrations of cervical proinflammatory cytokines early in pregnancy, is a risk factor for clinical chorioamnionitis.
  
  
  METHODS
  Interleukin-1beta, interleukin-6, and interleukin-8 were measured by enzyme-linked immunosorbent assay in cervical fluid from a cohort of 403 women at 8 to 20 weeks of gestation.
  
  
  RESULTS
  Of the 88 women with one low cytokine concentration, 8.0% of the women had clinical chorioamnionitis compared with 4.4% among the 228 women with no low cytokines (adjusted odds ratio, 2.0; 95% CI, 0.7-5.8). Clinical chorioamnionitis occurred in 15 of the 87 women (17.2%), with two or three depressed cytokine concentrations compared with women with no low cytokines (adjusted odds ratio, 5.1; 95% CI, 2.0-13.0).
  
  
  CONCLUSIONS
  Genital tract immune hyporesponsiveness, as represented by low cervical concentrations of multiple cytokines, permits subsequent clinical chorioamnionitis.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Research Institute, Pittsburgh, PA 15213, USA. hsimhan@mail.magee.edu
authors.forename: Hyagriv N
authors.initials: HN
authors.lastname: Simhan
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Marijane A
authors.initials: MA
authors.lastname: Krohn
authors.forename: Begoña
authors.initials: B
authors.lastname: Martinez de Tejada
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Landers
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Hillier
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D002584:Cervix Uteri / Q000378:metabolism*; D002821:Chorioamnionitis / Q000209:etiology*; D016207:Cytokines / Q000378:metabolism*; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D016015:Logistic Models; D016017:Odds Ratio; D009994:Osmolar Concentration; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000209:etiology*; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000378:metabolism; D044465:White People
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators