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Obstetrics & Gynecology 2005;106:73-80
© 2005 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Serum C-reactive Protein and Chlamydia trachomatis Antibodies in Preterm Delivery

Liisa Karinen, MD, Anneli Pouta, MD, PhD, Aini Bloigu, BSc, Pentti Koskela, PhD, Mika Paldanius, MNSc, Maija Leinonen, PhD, Pekka Saikku, MD, PhD, Marjo-Riitta Jêrvelin, MD, PhD and Anna-Liisa Hartikainen, MD, PhD

From the Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland; Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland; National Public Health Institute, Oulu, Finland; Department of Medical Microbiology, University of Oulu, Oulu, Finland; and Department of Epidemiology and Public Health, Imperial College of London, London, United Kingdom.

Address reprint requests to: Address correspondence to: Liisa Karinen, Department of Obstetrics and Gynecology, University Hospital of Oulu, PO Box 24, FIN-90029 OYS, Finland; e-mail: Liisa.Karinen{at}oulu.fi.

OBJECTIVE: To assess the association between Chlamydia trachomatis antibodies, antibodies to C trachomatis heat shock proteins 60 and 10, and C-reactive protein (CRP) levels in maternal serum measured by highly sensitive CRP assay during the first trimester and spontaneous preterm delivery before 37 weeks of gestation.

Methods: This was a nested case–control study of 104 spontaneous preterm singleton deliveries (cases) and 402 term singleton deliveries, as controls, of mothers belonging to the population-based Northern Finland 1966 Birth Cohort. Data on 2,309 first deliveries were available from the Finnish Medical Birth Register. Serum C trachomatis and C pneumoniae antibodies were measured by the microimmunofluorescence test and chlamydial heat shock proteins 60 and 10 antibodies by enzyme immunoassay using recombinant proteins as antigens, and highly sensitive CRP levels were quantified with highly sensitive immunoenzymometric assay.

Results: Highly sensitive CRP levels were higher and C trachomatis immunoglobulin G levels (pools and individual serotypes) were more often present (thought not nominally significantly in all cases) in the women with preterm compared with term deliveries. Elevated immunoglobulin G levels of C trachomatis antibodies or elevated highly sensitive CRP levels alone, however, did not increase the estimated risk for preterm delivery, but when they were present simultaneously, the estimated risk for preterm delivery was 4-fold (odds ratio 4.3, 95% confidence interval 2.0–9.3). Among the women delivered at or before 34 weeks of gestation, the estimated risk was even more evident (odds ratio 5.6, 95% confidence interval 2.1–14.5). The preterm delivery rate was 26.5% for those with C trachomatis antibodies and 18.8% for those without C trachomatis antibodies.

Conclusion: The results of the present study suggest that chlamydial infection in the first trimester is associated with preterm delivery.

Level of Evidence: II-2






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