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Bacterial Vaginosis, Vaginal Fluid Neutrophil Defensins, and Preterm Birth

From the Department of Epidemiology, School of Public Health, Carolina Population Center, Department of Obstetrics and Gynecology, School of Medicine, and Division of Infectious Diseases, Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; and Section of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, New Jersey.

Address reprint requests to: David A. Savitz, PhD, The University of North Carolina at Chapel Hill, Department of Epidemiology, CB #7435 McGavran Greenberg Building, Chapel Hill, NC 27599-7400; E-mail: david_savitz{at}unc.edu.

OBJECTIVE: To examine the association between bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth.

METHODS: Vaginal fluid specimens were obtained at 24–29 weeks’ gestation from 242 cases with preterm birth and 507 noncases sampled using a case–cohort study design. We tested for bacterial vaginosis by Gram staining and Nugent scores and assayed for neutrophil defensins by enzyme-linked immunosorbent assay. Bacterial vaginosis was studied as a categoric variable (negative, intermediate, and positive), whereas defensins were studied as a continuous, categoric (based on percentiles), and dichotomous measure (presence versus absence). Three gestational age cut points were used to define preterm birth. Modified Cox proportional hazard models were used to evaluate the associations between bacterial vaginosis, defensins, and degree (less than 32, less than 34, and less than 37 weeks) and type (premature rupture of membranes, preterm labor) of pre-term birth.

RESULTS: Elevated vaginal fluid neutrophil defensins were not associated with birth before 37 weeks. Compared with women who did not have measurable vaginal fluid defensins, women with higher defensin levels (0–2.8 µg/mL, 2.8–8.2 µg/mL, and greater than 8.2 µg/mL) had a greater risk of delivering before 32 weeks. Hazard ratios adjusted for maternal race and vaginal bleeding during pregnancy and 95% confidence intervals for these defensin levels were 1.7 (0.4, 6.9), 2.4 (0.7, 7.9), and 3.1 (1.0, 9.8), respectively. Bacterial vaginosis status did not influence the association between defensins and preterm birth.

CONCLUSION: Elevated concentrations of vaginal fluid neutrophil defensins at 24–29 weeks’ gestation might predict preterm birth before 32 weeks.

This article has been cited by other articles:

				J. Xu, C. B. Holzman, C. G. Arvidson, H. Chung, and A. R. Goepfert Midpregnancy Vaginal Fluid Defensins, Bacterial Vaginosis, and Risk of Preterm Delivery Obstet. Gynecol., September 1, 2008; 112(3): 524 - 531. [Abstract] [Full Text] [PDF]