Prenatal plasma matrix metalloproteinase-9 levels to predict spontaneous preterm birth

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Abstract
Objective: Matrix metalloproteinase-9, a zinc-dependent proteinase, may be important in initiating labor or rupture of membranes. We determined plasma levels of this enzyme in nonpregnant and pregnant women and evaluated whether they predict spontaneous preterm delivery. Methods: A sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure matrix metalloproteinase-9 levels in plasma samples from 25 nonpregnant women (mean age 39 ± 9 years) and in stored plasma samples obtained during a randomized trial of zinc supplementation in pregnancy. Women were selected who delivered following spontaneous labor or premature rupture of membranes at 24–32 weeks (n = 20), 33–36 weeks (n = 29), and greater than 37 weeks (n = 30). Plasma samples were obtained sequentially at 19, 26, 31, and 36 weeks if undelivered and at presentation for delivery. Results: Plasma matrix metalloproteinase-9 levels for nonpregnant women averaged 18.6 ± 11.2 (mean ± standard deviation) ng/mL. Prenatal values averaged 298 ± 227 ng/mL from 19 weeks until 36 weeks (not including presentation for delivery) and did not change significantly as the gestational age increased, regardless of whether women ultimately delivered at 24–32, 33–36, or after 37 weeks. Values obtained prior to, but within 1 week of, presentation for delivery (n = 7, 281 ± 103 ng/mL) were not significantly different than those obtained earlier in pregnancy (n = 71, 309 ± 307 ng/mL, [P = .60]). Plasma matrix metalloproteinase-9 levels for women in spontaneous labor were similar regardless of gestational age and were increased three-fold (852 ± 301 ng/mL) compared with those drawn at each prenatal visit (for example, 26 week values = 285 ± 144 ng/mL [P < .001]). Conclusion: Plasma matrix metalloproteinase-9 levels remain unchanged throughout pregnancy until the onset of spontaneous labor when there is a three-fold increase. Plasma matrix metalloproteinase-9 levels obtained prior to presentation for delivery do not appear to predict spontaneous preterm birth.

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