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Objective To establish whether there is an association between preterm delivery and either group B streptococcal urinary infection or the presence of urinary antibodies to group B streptococcal or E. coli antigens.Design A prospective study with urine culture and antibody measurement performed at the first antenatal visit and at 28 weeks gestation.Setting Ninewells Hospital, Dundee.Subjects Two thousand and forty-three women registering consecutively at an antenatal clinic.Main outcome measure Delivery at less than 37 weeks gestation. ResultsNo increase in preterm delivery was observed in women with positive urine cultures for group B streptococci either at booking or at 28 weeks, even when confirmed by positive repeat cultures. Preterm delivery was more common in women with elevated urinary antibodies to E. coli antigens at booking (relative risk 1.81, 95% CI 1.22-2.68, P = 0.005) and at 28 weeks (relative risk 2.36, 95% CI 1-60-3-48, P < 0.0001) and to group B streptococcal antigens at 28 weeks (relative risk 2-24, 95% CI 1.46-3.43, P = 0.0003). Conclusions These data do not support previous reports that positive urine cultures for group B streptococci are associated with an increased risk of preterm delivery. Our report of an association between elevated levels of urinary antibodies and preterm delivery is a new finding consistent with the possibility that a local inflammatory response to uro-genital infection may be important in stimulating the onset of preterm labour. The results suggest that screening for urinary antibodies at 28 weeks gestation might help to identify a group of women at increased risk of prematurity.Infection with many different organisms may play a role in the pathogenesis of preterm delivery. Several studies have suggested an association between colonisation of the genital tract by group B streptococci and both preterm delivery and premature rupture of membranes (Regan et al. 1981;Alger et al. 1988;McDonald et al. 1989). However, other investigators (Hastings et al. 1986) have

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A radial immunodiffusion technique has been used to measure levels of four serum proteins in preeclampsia with or without proteinuria and in normal pregnant and non-pregnant controls. In preeclampsia unaccompanied by proteinuria, albumin and transferrin levels are similar to those found in the normal pregnant controls, but there are significant falls in 0x2-macroglobulin and IgG. When preeclampsia is accompanied by proteinuria there is a marked fall in albumin and an increase in o'2-macroglobulin. Since oU2-macroglobulin has antiplasmin activity it is possible that increased levels of this protein in preeclampsia accompanied by proteinuria contribute to the intravascular coagulation which has been described in this disorder.Both in pregnancy and the nephrotic syndrome increased levels of serum x2-macroglobulin have been reported (Schumacher and Schlumberger, 1963;Schultze and Schwick, 1959). We therefore thought it would be of interest to determine the serum oI2-macroglobulin levels in preeclampsia, a complication of pregnancy which bears a certain similarity to the nephrotic syndrome. For comparison the serum levels of transferrin, IgG, and albumin have also been measured to demonstrate changes due to factors such as haemodilution.We report here the serum levels of c2-macroglobulin, transferrin, IgG, and albumin, assayed by a radial immunodiffusion technique, in preeclampsia and in matched normal pregnant and non-pregnant controls. Subjects and MethodsSera were obtained from four groups of patients: (1) preeclampsia with proteinuria (13 cases); (2) preeclampsia without proteinuria (13 cases); (3) normal pregnant (26 cases); (4) non-pregnant (26 cases). Preeclampsia was defined as hyper-