Pregnancy-induced changes in immune protection of the genital tract: defining normal

Anderson, Brenna L.; Mendez‐Figueroa, Hector; Dahlke, Joshua D.; Raker, Christina; Hillier, Sharon L.; Cu‐Uvin, Susan

doi:10.1016/j.ajog.2013.01.014

Cited by 28 publications

(26 citation statements)

References 29 publications

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“…The negative relationship between Lactobacillus and CRP in pregnancy is consistent with the observation that Lactobacillus dominates the vaginal flora in healthy women [66] and that many species of Lactobacillus are considered to be protective [67]. It is also consistent with the lower amount of Lactobacillus but higher CRP in pregnant compared with non-pregnant women in the US [68]. In addition, however, the typical pathogenic bacteria associated with BV, Bacterioides/Gardnerella and Mobiluncus [69], were also associated with lower CRP in pregnancy and lactation, respectively.…”

Section: Discussionsupporting

confidence: 82%

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

et al. 2017

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BackgroundThe usefulness of C-reactive protein (CRP) as a non-specific marker of inflammation during pregnancy and lactation is unclear in impoverished populations where co-existing infections and vitamin deficiencies are common.MethodsThis cross-sectional study in Panama recruited 120 pregnant and 99 lactating Ngäbe-Buglé women from 14 communities in rural Panama. Obstetric history, indoor wood smoke exposure, fieldwork, BMI, vitamins A, B12, D, and folic acid, and inflammation markers (CRP, neutrophil/lymphocyte ratio (NLR), plateletcrit and cytokines) were measured. Multiple regressions explored both associations of CRP with other inflammatory markers and associations of CRP and elevated CRP based on trimester-specific cut-offs with maternal factors, infections and vitamin deficiencies.ResultsCRP was higher in pregnancy (51.4 ± 4.7 nmol/L) than lactation (27.8 ± 3.5 nmol/L) and was elevated above trimester specific cut-offs in 21% of pregnant and 30% of lactating women. Vitamin deficiencies were common (vitamin A 29.6%; vitamin D 68.5%; vitamin B12 68%; folic acid 25.5%) and over 50% of women had two or more concurrent deficiencies as well as multiple infections. Multiple regression models highlighted differences in variables associated with CRP between pregnancy and lactation. In pregnancy, CRP was positively associated with greater indoor wood smoke exposure, caries and hookworm and negatively associated with Ascaris and vaginal Lactobacillus and Bacteroides/Gardnerella scores. Consistent with this, greater wood smoke exposure, caries as well as higher diplococcal infection score increased the odds of trimester-elevated CRP concentrations whereas longer gestational age lowered the likelihood of a trimester-elevated CRP. During lactation, folic acid deficiency was associated with higher CRP whereas parity, number of eosinophils and Mobiluncus score were associated with lower CRP. Also, a higher BMI and Trichomonas vaginalis score increased the likelihood of an elevated CRP whereas higher parity and number of eosinophils were associated with lower likelihood of an elevated CRP.ConclusionsInfections both raise and lower CRP concentrations in pregnant and lactating mothers. Only folic acid deficiency during lactation was associated with higher CRP concentrations. Caution is required when interpreting CRP concentrations in pregnant and lactating women who have co-existing nutrient deficiencies and multiple infections.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0307-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 82%

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

et al. 2017

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“…Less is known regarding immune functions in the genital tract, which is critical to consider in order to prevent sexual acquisition/transmission of HIV. Further, other factors that can affect immune milieu of female reproductive tract (FRT) including protein content, presence of infections and vaginal pH, also need to be considered in determining HIV susceptibility in women [18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Reduced levels of genital tract immune biomarkers in postmenopausal women: implications for HIV acquisition

Jais

Younes

Chapman

et al. 2016

American Journal of Obstetrics and Gynecology

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“…Although pregnancy is known to alter the maternal immune milieu 1–3 , it is unknown whether the sex of the fetus results in distinct maternal immune changes throughout the course of pregnancy. This question is relevant given that several observations of disparate outcomes in pregnancy are based on fetal sex 4, 5 .…”

Section: Introductionmentioning

confidence: 99%

Fetal Sex‐Based Differences in Maternal Hormones, Angiogenic Factors, and Immune Mediators During Pregnancy and the Postpartum Period

Enninga

Nevala

Creedon

et al. 2014

American J Rep Immunol

128

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Problem Several pregnancy complications have disparities based on the sex of the fetus. It is unknown whether the sex of the fetus differentially alters the maternal immune milieu, potentially contributing to the observed differences. Method of Study Using maternal plasma collected during 38 uncomplicated pregnancies (19 males, 19 females), we compared levels of cytokines, sex hormones, and angiogenic factors throughout gestation and post-partum. Results Male fetal sex was associated with higher levels of proinflammatory cytokines (G-CSF, IL-12p70, IL-21, and IL-33) and angiogenic factors (PlGF and VEGF-A) compared to female fetal sex at multiple timepoints. Female fetal sex was associated with higher levels of regulatory cytokines (IL-5, IL-9, IL-17, and IL-25). IL-27 increased throughout pregnancy regardless of fetal sex. There was no fetal sex-based difference in analyte concentrations at the post-partum measurement. Conclusion Women carrying a male fetus exhibit a more proinflammatory/proangiogenic immune milieu than women carrying a female fetus.

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Pregnancy-induced changes in immune protection of the genital tract: defining normal

Cited by 28 publications

References 29 publications

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

C-reactive protein is differentially modulated by co-existing infections, vitamin deficiencies and maternal factors in pregnant and lactating indigenous Panamanian women

Reduced levels of genital tract immune biomarkers in postmenopausal women: implications for HIV acquisition

Fetal Sex‐Based Differences in Maternal Hormones, Angiogenic Factors, and Immune Mediators During Pregnancy and the Postpartum Period

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