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Amniotic fluid proteomic signatures of cervical insufficiency and their association with length of latency
Author(s) -
Govia Rachelle N. M.,
Birse Kenzie D.,
Sepehri Shadi,
Khafipour Ehsan,
Menticoglou Savas M.,
Burgener Adam D.,
Poliquin Vanessa
Publication year - 2018
Publication title -
american journal of reproductive immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.071
H-Index - 97
eISSN - 1600-0897
pISSN - 1046-7408
DOI - 10.1111/aji.13030
Subject(s) - cervical insufficiency , amniotic fluid , amniocentesis , medicine , gestational age , cervical cerclage , pregnancy , obstetrics , gynecology , gastroenterology , andrology , fetus , cervix , prenatal diagnosis , biology , genetics , cancer
Problem Cervical insufficiency is a precursor of preterm birth. Treatment with emergency cervical cerclage is contraindicated in the presence of intra‐amniotic infection. Detecting infection with Gram stain and culture of amniotic fluid lacks sensitivity. Proteomic profiling of amniotic fluid in cervical insufficiency may help identify pregnancies best suited for emergency cerclage. Method of study Thirty‐two pregnant women underwent amniocentesis for routine genetic testing (n = 22) or after diagnosis of cervical insufficiency (n = 10). The proteomic profiles of the amniotic fluid samples were compared in a cross‐sectional fashion, including sub‐analyses of women with cervical insufficiency and latency periods of <1 week and >1 week post‐diagnosis. Results Mean gestational age at diagnosis of cervical insufficiency was 21.4 weeks (95% CI 20.6‐22.1). Proteomic analysis yielded 40 (7.2%, P < 0.05) differentially expressed proteins between women with delivery <1 week (n = 6) vs. >1 week (n = 4). Women who delivered <1 week had activated inflammatory response ( z = 2.3, P = 6.71E−09), chemotaxis of immune cells ( z = 2.9, P = 2.01E−08), and inhibited bacterial growth ( z = ‐2.2, P = 5.82E−05). A multivariate model of eight biomarkers positively associated with cases of <1 week latency and distinguished cases from controls (97.8%, cross‐validation accuracy 92.7%, P = 0.0009). Conclusion In this pilot study, significant differences in the amniotic fluid proteomic profiles in cases of cervical insufficiency compared to genetic amniocentesis were observed. Proteomic signatures were predictive of achieving latency > 1 week after diagnosis of cervical insufficiency. These preliminary findings suggest that proteomic analysis may be of value in predicting outcome following cervical insufficiency and warrants further validation in larger studies.