Combined elevated midpregnancy tumor necrosis factor alpha and hyperlipidemia in pregnancies resulting in early preterm birth.
OBJECTIVE
The objective of the study was to determine whether pregnancies resulting in early preterm birth (PTB) (<30 weeks) were more likely than term pregnancies to have elevated midtrimester serum tumor necrosis factor alpha (TNF-α) levels combined with lipid patterns suggestive of hyperlipidemia.


METHODS
In 2 nested case-control samples drawn from California and Iowa cohorts, we examined the frequency of elevated midpregnancy serum TNF-α levels (in the fourth quartile [4Q]) and lipid patterns suggestive of hyperlipidemia (eg, total cholesterol, low-density-lipoproteins, or triglycerides in the 4Q, high-density lipoproteins in the first quartile) (considered independently and by co-occurrence) in pregnancies resulting in early PTB compared with those resulting in term birth (n = 108 in California and n = 734 in Iowa). Odds ratios (ORs) and 95% confidence intervals (CIs) estimated in logistic regression models were used for comparisons.


RESULTS
Early preterm pregnancies were 2-4 times more likely than term pregnancies to have a TNF-α level in the 4Q co-occurring with indicators of hyperlipidemia (37.5% vs 13.9% in the California sample (adjusted OR, 4.0; 95% CI, 1.1-16.3) and 26.3% vs 14.9% in the Iowa sample (adjusted OR, 2.7; 95% CI, 1.1-6.3). No differences between early preterm and term pregnancies were observed when TNF-α or target lipid abnormalities occurred in isolation. Observed differences were not explicable to any maternal or infant characteristics.


CONCLUSIONS
Pregnancies resulting in early PTB were more likely than term pregnancies to have elevated midpregnancy TNF-α levels in combination with lipid patterns suggestive of hyperlipidemia.
Genetic Disease Screening Program, California Department of Public Health, Richmond, and the Division of Preventive Medicine and Public Health, Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA. Electronic address: laura.jelliffe@cdph.ca.gov.
Laura L
LL
Jelliffe-Pawlowski
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
Kelli K
KK
Ryckman
Department of Pediatrics, University of Iowa School of Medicine, Iowa City, IA.
Bruce
B
Bedell
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Hugh M
HM
O'Brodovich
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA.
Jeffrey B
JB
Gould
Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
Dierdre J
DJ
Lyell
California Perinatal Quality Care Collaborative, Palo Alto, CA.
Kristi S
KS
Borowski
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Gary M
GM
Shaw
Department of Pediatrics, University of Iowa School of Medicine, Iowa City, IA.
Jeffrey C
JC
Murray
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
David K
DK
Stevenson
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002140:California; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood* / Q000175:diagnosis; D007231:Infant, Newborn; D007484:Iowa; D008055:Lipids / Q000097:blood*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000175:diagnosis; D011262:Pregnancy Trimester, Second / Q000097:blood; D047928:Premature Birth / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
D008055:Lipids; D014409:Tumor Necrosis Factor-alpha
early preterm birth; hyperlipidemia; term pregnancy; tumor necrosis factor alpha