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Phosphorylated Isoforms of Insulin-Like Growth Factor Binding Protein-1 in the Cervix as a Predictor of Cervical Ripeness

From the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland; and Medix Biochemica, Kauniainen, Finland.

Address reprint requests to: Mika Nuutila, MD Department of Obstetrics and Gynecology Helsinki University Central Hospital Haartmaninkatu 2, PO Box 140 FIN-00029 HUCH Finland E-mail: mika.nuutila{at}huch.fi

Objective: To study the isoforms of insulin-like growth factor binding protein-1 (IGFBP-1) in cervical secretion and to evaluate whether their assessment could serve in prediction of cervical ripeness at term.

Methods: We measured the concentrations of IGFBP-1 in cervical swab samples of 64 women scheduled for labor induction by amniotomy or cervical ripening with prostaglandin E₂ gel. Two immunoenzymometric assays were used: a previously described assay 1, which detects the nonphosphorylated and lesser phosphorylated isoforms, and a novel assay 2, which detects the lesser and highly phosphorylated isoforms of IGFBP-1. A set of 39 amniotic fluid (AF) samples also was analyzed to compare the phosphorylation status of IGFBP-1 in cervical secretion with that in AF.

Results: In all cervical samples, IGFBP-1 concentration was higher by assay 2 than by assay 1, whereas in all AF samples, the results were the opposite. Initially, the median IGFBP-1 concentration in the ripe cervices (Bishop scores 6 or greater; n = 29) was approximately four times as high as that in the unripe cervices (Bishop scores 5 or less; n = 35). The cervical IGFBP-1 concentrations increased eight-fold in 6 hours after the first application of PGE₂.

Conclusion: Phosphorylated isoforms of IGFBP-1, different from those in AF, are present in the cervical secretion of women with intact fetal membranes and reflect cervical ripeness. A bedside test for those IGFBP-1 isoforms might help in predicting amenability for labor induction.

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