title: Plasma C-reactive protein in early pregnancy and preterm delivery.
abstract: Systemic maternal infections have been associated with preterm delivery. The authors examined the association of C-reactive protein (CRP), a marker of inflammation, with preterm delivery. This nested case-control study was conducted within Project Viva in Massachusetts between 1999 and 2002. Subjects were 117 women who delivered preterm (< 37 weeks' gestation) and 117 controls (term deliveries) matched on age, race/ethnicity, and smoking status. High-sensitivity CRP assays were performed on early-pregnancy (5.3-19.3 weeks' gestation) plasma samples. Odds ratios and 95% confidence intervals were estimated by using conditional logistic regression adjusted for matching factors, gestational age at blood collection, and prepregnancy body mass index. Median concentration of CRP was 3.2 mg/liter in cases versus 2.4 mg/liter in controls. No significant association was found between quartiles of CRP and preterm delivery. However, CRP levels exceeding the threshold defined in the literature were associated with increased risk of preterm delivery (odds ratio = 2.55, 95% confidence interval: 1.05, 6.02 for CRP > or = 8 mg/liter). The association was stronger among cases who experienced spontaneous delivery (odds ratio = 4.64, 95% confidence interval: 0.94, 22.96) versus indicated delivery (odds ratio = 1.42, 95% confidence interval: 0.44, 4.61). These findings suggest that very high CRP levels in early pregnancy are associated with preterm delivery.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. waranuch@kku.ac.th
authors.forename: Waranuch
authors.initials: W
authors.lastname: Pitiphat
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.forename: Kaumudi J
authors.initials: KJ
authors.lastname: Joshipura
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Chester W
authors.initials: CW
authors.lastname: Douglass
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy / Q000097:blood*; D047928:Premature Birth / Q000097:blood* / Q000453:epidemiology*; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein