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Association between cervicovaginal cytokines and fetal fibronectin in women at risk of spontaneous preterm labour
  1. M Chandiramani,
  2. P Seed,
  3. A H Shennan,
  4. R Tribe
  1. Division of Women's Health, King's College London and King's Health Partners, London, UK


Background An improved understanding of inflammatory events leading to cervical shortening in women at risk of spontaneous preterm labour (SPTL) is necessary. We undertook a longitudinal observational study to determine the relationship between cytokine and fetal fibronectin (fFN) concentrations in women at risk of SPTL.

Methods Women (n=112) with at least one previous preterm delivery were recruited (14–24 weeks' gestation) from two prematurity clinics and assessed (transvaginal cervical scans and cervico-vaginal fluid (CVF) swabs) every 2 weeks until 28 weeks. If cervical length shortened (<25 mm), women were randomised to cervical cerclage or progesterone and samples taken weekly. Concentrations of 11 cytokines were measured in CVF samples (n=477 from 78 women) using multiplex immunoassay. Concentrations of fFN were measured using ELISA (n=735 from 112 women). Data were analysed using STATA; results expressed as ratios (95% CI).

Results There was no difference in CVF fFN concentrations in women destined to develop a short cervix (n=36) compared to high-risk women without a short cervix (n=76). Women with a positive fFN exhibited higher CVF concentrations of interleukin-6 (IL) (1.53 (1.21–1.94), p<0.001) IL-7 (1.19 (1.02–1.39), p=0.03), Granulocyte colony-stimulating factor (G-CSF) (1.25 (1.00–1.57), p=0.05), interferon-γ (IFN-γ) (1.28 (1.01–1.61), p=0.04), monocyte chemoattractant protein 1 (MCP-1) (1.18 (1.00–1.38), p=0.05) and Macrophage inflammatory protein 1β (MIP-1) (1.43 (1.04–1.97), p=0.03) at the same gestational age. Doubling concentrations of IL-6 and TNF α were associated with a positive fFN test 2 weeks later (1.32 (1.00–1.73), p=0.05 and 1.50 (CI 1.01 to 2.24), p=0.05, respectively).

Conclusions Elevated CVF IL-6, IL-7, G-CSF, IFN-γ, MCP-1 and MIP-1β concentrations are associated with a positive fFN test. fFN does not appear to be involved in the processes leading to cervical shortening.

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  • Funding Action Medical Research (SP4113).