title: Pregnancy-induced changes in immune protection of the genital tract: defining normal.
abstract: OBJECTIVE
  Both the state of pregnancy as well as disruption of vaginal flora and immune mediators may increase the risk of human immunodeficiency virus-1 acquisition. The objective of this study was to define immune changes in lower genital and systemic immunity associated with normal pregnancy.
  
  
  METHODS
  This prospective cohort enrolled low-risk pregnant and nonpregnant women ages 18-35 years. Pregnant women at <14 weeks and nonpregnant women in follicular phase of the menstrual cycle were included. Cervical and vaginal fluid was collected. Concentrations of immune mediators were measured using enzyme-linked immunosorbent assay-based methods or multiplex immunoassay. Samples were inoculated onto various culture media allowing for growth of Lactobacillus species, Gardnerella vaginalis, Escherichia coli, Enterococcus species, anaerobic gram-negative rods, Candida, Staphylococcus aureus, Ureaplasma species, and Mycoplasma hominis. Concentrations of immune mediators and vaginal colonization frequencies were compared between the pregnant and nonpregnant groups.
  
  
  RESULTS
  Genital tract concentration of interleukin-1β was higher during pregnancy compared to nonpregnant participants. Serum C-reactive protein concentrations were higher in all trimesters of pregnancy. Concentrations of secretory leukocyte protease inhibitor did not differ between groups. Lactobacillus was more commonly isolated from vaginal cultures of nonpregnant participants (100% vs 70.2%, P = .02). Identification of Candida, G vaginalis, M hominis, and S aureus was common and not different between groups. Ureaplasma species was isolated from >60% pregnant participants.
  
  
  CONCLUSIONS
  The proinflammatory cytokine, interleukin-1β, as well as the systemic marker of inflammation, C-reactive protein, are increased during pregnancy. The impact of these proinflammatory changes during pregnancy deserves further study.
authors: Division of Maternal-Fetal Medicine, Women & Infants' Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors: Brenna L
authors: BL
authors: Anderson
authors: Hector
authors: H
authors: Mendez-Figueroa
authors: Joshua D
authors: JD
authors: Dahlke
authors: Christina
authors: C
authors: Raker
authors: Sharon L
authors: SL
authors: Hillier
authors: Susan
authors: S
authors: Cu-Uvin
mesh_terms: D000293:Adolescent; D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D002584:Cervix Uteri / Q000276:immunology / Q000382:microbiology; D005260:Female; D006801:Humans; D053583:Interleukin-1beta / Q000032:analysis*; D008597:Menstrual Cycle / Q000097:blood / Q000276:immunology*; D011247:Pregnancy / Q000276:immunology*; D011446:Prospective Studies; D014621:Vagina / Q000276:immunology* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D053583:Interleukin-1beta; D002097:C-Reactive Protein