Amniotic fluid concentrations of Interleukin‐1β, Interleukin‐6 and TNF‐α in chorioamnionitis before 32 weeks of gestation: histological associations and neonatal outcome

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Abstract
Objectives To test the association between cytokine levels in the amniotic fluid and (i) the vascular invasion phase of intrauterine infection, (ii) the occurrence of periventricular leukomalacia; to assess the correlation between C-reactive protein levels, a recognised biological marker of inflammation in maternal serum and cytokine levels in the amniotic fluid. Design Prospective clinical study. Setting Fetal medicine unit and neonatal intensive care unit, Antoine Beclere Hospital, Clamart, France. Sample Thirty-one pregnancies complicated by chorioamnionitis leading to birth before 32 weeks of gestation. Methods Interleukin 1-β, Interleukin 6 and TNF-α prospectively measured in the amniotic fluid. Histological examination of the placenta. Ultrasound examination and magnetic resonance imaging of the brains of the newborn infants performed within the first week of life. Main outcome measures The occurrence of periventricular leukomalacia was assessed by trans fontanellar ultrasound and magnetic resonance imaging. Results There was a significant positive correlation between the occurrence of histological chorioamnionitis, vascular extension of infection of the membranes, maternal inflammatory syndrome and neonatal sepsis. A strong association was found between maternal serum C-reactive protein concentrations and cytokine levels in the amniotic fluid. Interleukin-1β was the best predictor of vascular extension of chorioamnionitis, and TNF-α was the best predictor of the development of severe early neonatal infection. There was no association betwecn the amniotic fluid levels of cytokines and the development of periventricular leukomalacia. Conclusions These data suggest that IL-1β, IL-6 and TNF-α are produced in relation to intrauterine inflammation and infection, but cannot be directly implicated in the development of fetal cerebral white matter lesions.