title: Low levels of circulating T-regulatory lymphocytes and short cervical length are associated with preterm labor.
abstract: Recent discoveries suggest that T-regulatory lymphocytes (Treg) might play an important role in the pathophysiology of preterm labor. The aim of this study was to assess the relationship among the levels of maternal circulating Treg cells, uterine cervical length, and the risk of preterm labor. Sixty women with regular contractions and/or cervical incompetence at 24-32 weeks' gestation were recruited into a prospective study. Each patient underwent transvaginal ultrasound examination of the cervical length, and regulatory T cells were quantified in peripheral blood samples by flow cytometry. Patients with cervical incompetence were prescribed vaginal progesterone until birth. Measurements of Treg levels and cervical length correlated with the timing of labor. The risk of preterm labor happening within 48 h of testing was demonstrated to be almost 35 times higher (OR=35.21, CI 13.3; 214, p<0.001) in the group with simultaneously low Treg values (<0.031 × 10(9)/L) and a shortened uterine cervix (<17.5mm), compared with the situation where both of these values were normal. Similar results were found in predicting preterm delivery before 34 weeks, or between 34 and 37 weeks. A statistically nonsignificant trend toward increased cervical length and increased Treg count was noted in the women on progesterone treatment. We show for the first time that the combined assessment of Treg cell count and cervical length is a much better predictor of preterm delivery than either parameter used on its own. This combined approach may offer clinical application in patients who present with risk factors for preterm labor.
authors.affiliation: Department of Gynecology and Obstetrics of the First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Czech Republic. Electronic address: michalkoucky@seznam.cz.
authors.forename: Michal
authors.initials: M
authors.lastname: Koucký
authors.affiliation: Institute of Medical Biochemistry and Laboratory Diagnostics of the First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Czech Republic.
authors.forename: Karin
authors.initials: K
authors.lastname: Malíčková
authors.affiliation: Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom.
authors.forename: Tereza
authors.initials: T
authors.lastname: Cindrová-Davies
authors.affiliation: Department of Gynecology and Obstetrics of the First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Czech Republic; Institute of Medical Biochemistry and Laboratory Diagnostics of the First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Czech Republic.
authors.forename: Anna
authors.initials: A
authors.lastname: Germanová
authors.affiliation: Department of Gynecology and Obstetrics of the First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Czech Republic.
authors.forename: Antonín
authors.initials: A
authors.lastname: Pařízek
authors.affiliation: Institute of Medical Biochemistry and Laboratory Diagnostics of the First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Czech Republic.
authors.forename: Marta
authors.initials: M
authors.lastname: Kalousová
authors.affiliation: Department of Gynecology and Obstetrics of the First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Czech Republic.
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Hájek
authors.affiliation: Institute of Medical Biochemistry and Laboratory Diagnostics of the First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Zima
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000166:cytology / Q000502:physiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D011247:Pregnancy; D011374:Progesterone / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D012306:Risk; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*
chemical_list: D011374:Progesterone
keywords: Cervical incompetence; Preterm labor; T-regulatory lymphocytes; Ultrasound cervical length