1. In a cohort of pregnant women in Beijing, elevated high-sensitivity C-reactive protein (hsCRP) was associated with increased risk of preterm delivery in twin gestations
Evidence Rating Level: 2 (Good)
Preterm delivery (PTD) is related to high infant morbidity and mortality in twin gestations, with the risk of PTD being up to 56.6% in twin gestations. PTD can be spontaneous PTD (sPTD), or medical induced PTD (mPTD), accounting for 60-70% and 30-40% of PTD respectively. The etiology of sPTD is multifactorial including mechanisms such as inflammation and uteroplacental ischemia. C-reactive protein (CRP) is a biomarker in response to inflammation, and high-sensitive CRP (hs-CRP) can reflect low-grade inflammation. Studies in the past have found elevated maternal CRP or hsCRP was associated with an increased risk of sPTD but limited studies have involved twin gestations. This study involved 618 twin gestations from a tertiary hospital in Beijing, with serum samples collected from early pregnancy analyzed for hsCRP. 48.87% were classified as PTD. The adjusted analysis showed a serum hsCRP higher in PTDs compared to term deliveries (2.13 mg/L, 95% confidence interval [CI] 2.09 –2.16 vs (1.84 mg/L, 95% CI 1.80 –1.88) (P < 0.001). The highest tertile of hsCRP was associated with increased risk of PTD compared to the lowest tertile. High values of serum hsCRP in early pregnancy were associated with preterm deliveries in the subgroup of spontaneous preterm deliveries (ARR 1.49, 95%CI:1.08–1.93). Limitations to the study include difficulty generalize results as 85.2% of participants were nulliparous. Additionally, serum hsCRP was measured during the first trimester with no values for the second and third trimesters. Overall, this study found that hsCRP was positively associated with increased risk of sPTD among twin gestations, indicating that inflammatory changes in early pregnancy may influence timing of labour. Future studies investigating more inflammatory markers, and those examining markers from each trimester as well as studies including multiparous patients are needed to continue to investigate and mitigate risk factors for PTD.
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