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Characterization of the Inflammatory Cytokines in the Vagina During Pregnancy and Labor and With Bacterial Vaginosis

Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; Genzyme Corporation, Cambridge, Massachusetts; Connective Therapeutics, Inc., Palo Alto, California; Ohio State University College of Medicine, Department of Obstetrics and Gynecology, 561 Means Hall, 1654 Upham Drive, Columbus, OH 43210

Phillip C. Greig, MD

Charles H. Livengood, III, MD

Emily Shunior, BA

Paul Durda, PhD

Mark Erikson, BS

Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; Genzyme Corporation, Cambridge, Massachusetts; Connective Therapeutics, Inc., Palo Alto, California

Objectives: 1) To characterize the presence of interleukin-1 alpha (IL-1), interleukin-1 beta (IL-1ß), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-) in the vagina during pregnancy and in labor; 2) to compare the vaginal level of these inflammatory cytokines between laboring nad nonlaboring patients; and 3) to compare the vaginal levels of these cytokines between women with and without bacterial vaginosis (BV).

Methods: Vaginal fluid was obtained by lavage from pregnant women with intact membranes at various gestational ages and during labor at term. These samples were analyzed for specific cytokine levels using standard enzyme-linked immunosorbent assay techniques. A Gram stain, wet mount, and pH were obtained from the vaginal fluid and were used to diagnose BV. The Mann-Whitney U test was used to evaluate the individual cytokine levels between groups, with P < .05 considered statistically significant.

Results: There was a wide range of vaginal cytokine levels found in our pregnant population (N = 72). Vaginal levels of IL-1ß (median 1070 versus 245.7 pg/mL) and IL-6 (9.0 versus 0 pg/mL) were found to be significantly elevated in laboring patients as compared with nonlaboring patients (P = .005 and P = .002, respectively). There were no significant differences in the levels of IL-1 and TNF- between the laboring and nonlaboring women. Interleukin-1ß was also found to be significantly elevated in the group of patients with BV (3364 versus 245.7 pg/mL; P = .01), particularly those who were nonlaboring (P = .003). In each individual patient, there was a wide variation in the levels of the four different cytokines.

Conclusions: Measurable levels of the inflammatory cytokines IL-1, IL-1ß, IL-6, and TNF- were present in the vagina during pregnancy and labor. Vaginal levels of IL-1ß and IL-6 were found to be significantly elevated in laboring patients as compared with nonlaboring patients. Vaginal levels of IL-1ß were also significantly elevated in nonlaboring patients with BV.

Key Words: Labor • bacterial vaginosis • vaginal cytokines • interleukin-1ß • interleukin-6

Journal of the Society for Gynecologic Investigation, Vol. 4, No. 2, 90-94 (1997)
DOI: 10.1177/107155769700400208


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