Maternal Serum C-Reactive Protein Concentration Early in Pregnancy and Subsequent Pregnancy Loss

Abstract

The purpose of this study was to determine the relationship between maternal inflammation and first or second trimester pregnancy loss. A nested case-control analysis was performed among the cohort enrolled in the Oral Conditions and Pregnancy study. We compared maternal serum C-reactive protein concentration between women with a pregnancy loss at < 21 weeks gestation to control women without gestational diabetes or preeclampsia who delivered at term. Participants were 2:1 frequency matched to cases by maternal age, race, and prior preterm birth. Median concentration of serum C-reactive protein between cases and controls was compared using Wilcoxon rank sum test. The potential effects of maternal smoking, gestational age at blood draw, and insurance status were evaluated and an adjusted odds ratio (95% confidence interval) for pregnancy loss was calculated using multivariable logistic regression. Among 1224 participants, 102 (9.8%) experienced pregnancy loss and 44 had complete information available. Median serum C-reactive protein concentration was significantly higher in controls compared with all cases (3.2 versus 0.5 microg/mL; p < 0.001). However, when stratified by gestational age at the time of the loss, median serum C-reactive protein level among controls was similar to those with a loss at less than 12 weeks (3.2 versus 2.0 microg/mL) but significantly higher compared with those whose loss occurred at greater than 12 weeks gestation (3.2 versus 0.5 microg/mL; p < 0.05). After adjusting for maternal smoking, gestational age at blood draw, and insurance status, women whose serum C-reactive protein level was greater than the 75% percentile had a decreased odds ratio for pregnancy loss (0.20; 95% confidence interval, 0.06 to 0.65). Pregnancy loss is not associated with increased systemic inflammation as measured by maternal serum C-reactive protein. Future study should be directed at determining the role of maternal inflammation during early pregnancy development and placentation.

Systemic Inflammation Is Associated with Ovarian Follicular Dynamics during the Human Menstrual Cycle

“…In addition, intentional local endometrial inflammation during blastocyst transfer following IVF has been shown to improve pregnancy outcomes [63]. Increased maternal CRP may be associated with protection from pregnancy loss, particularly in losses greater than 12 weeks gestation [64]. Thus, an inflammatory response has been suggested to be a positive signal for implantation; however, too much (or too little) inflammation may indicate pathology [62], [65].…”

Enfermedades periodontales durante el embarazo y su asociación con parto prematuro y bajo peso al nacimiento: Evidencias y controversias

“…En otros estudios se pone de manifiesto que el tratamiento y la profilaxis de la enfermedad periodontal reduce el riesgo de parto prematuro y el bajo peso al nacer (4, 21,32) y que por tanto es de gran importancia el control de la salud periodontal durante el proceso gestacional (22,(32)(33)(34).…”

“…La combinación de los mediadores de la inflamación junto con el aumento de la concentración hormonal, puede llegar a constituir un factor de riesgo para la integridad de la unidad fetoplacentaria en mujeres con una respuesta inmunitaria celular reducida como consecuencia del embarazo (9,31,34).…”

C-Reactive Protein Levels in Pregnancy

“…The authors reported that elevated fetal CRP levels at delivery were associated with higher long-term average maternal exposure to PM 10 (particulate matter ≤ 10 µm in aerodynamic diameter) and NO 2 (nitrogen dioxide). Other studies have reported that neither preeclampsia (Kristensen et al 2009) nor pregnancy loss (Boggess et al 2005) is associated with a systemic inflammation as reflected by CRP levels. However, van den Hooven et al (2012) insisted that exposure to air pollution may lead to systemic inflammation in pregnancy.…”