Maternal Cytokine Production Capacity as a Novel Indicator of Readiness for Labor: A Pilot Study among a Prospective Cohort of Low-Risk Black Women
Loading...
Date
2021-05
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
The Ohio State University
Abstract
Introduction. In the United States, 27.1% of labors are induced and 31.9% of births are by cesarean section. When unwarranted, interventions introduce risk, particularly among Black women. Unnecessary medical intervention is less common when women are admitted physiologically ready for labor, which is difficult to discern. Since an inflammatory cascade plays a major role in labor, we aimed to determine whether maternal immune profiles predict odds of spontaneous versus medically-initiated labor and birth.
Methods. A prospective cohort of Black women was recruited from central Ohio (n=92). At 28-32 weeks of pregnancy, demographics and obstetric histories were obtained. Whole blood was collected and incubated with lipopolysaccharide. Cytokine production was quantified. Medical records were reviewed. Associations among cytokine production capacity and odds of spontaneous versus medically-initiated labor and birth were examined by logistic regression (controls: age, education, smoking, body mass index, nulliparity, hypertension, fetal sex).
Results. Women with medically-indicated inductions or cesarean sections were excluded (n=18), leaving an analytical sample of 74 (54 spontaneous labors, 7 labor inductions, 13 pre-labor cesarean sections). Pro-inflammatory IL-6 production in the high versus mid-tertile (p=0.012; χ2quadratic=5.5, p=0.019) and anti-inflammatory IL1Ra production in the high versus low tertile (p=0.049) predicted lower odds of spontaneous labor. Anti-inflammatory TNFRII production in the low (p=0.027) and high (p=0.014) versus mid-tertile predicted lower odds of spontaneous labor (χ2quadratic=6.1, p=0.014).
Conclusions. We are among the first to provide data suggesting that maternal cytokine production capacity may show predictive power for labor readiness. Future work will benefit from additional immune profiling immediately preceding and during labor and larger cohorts. This line of inquiry has the potential to transform allocation of labor interventions.
Description
MNRS Perinatal, Sexual, and Reproductive Health RIG Undergraduate Student Research Award, MNRS Annual Conference Presentation 2021
Keywords
Obstetric, Immune, African American, Intrapartum