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Physiology/Endocrinology

Poster Session 3

(687) Immune Clock of Pregnancy: A Longitudinal Evaluation of Cervicovaginal Inflammation

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Timed changes in circulating immune mediators have been reported to play a critical role in fetal tolerance and fetal growth while providing anti-microbial protection. However, similar longitudinal adaptations occurring in the cervicovaginal space are less well understood. Our goal was to evaluate inflammatory changes over time utilizing cervicovaginal lavage (CVL) in a normal patient population.  

Study Design: This is a single center, prospective case-control cohort study of pregnant patients at risk for spontaneous preterm birth (sPTB). The control cohort consists of nulliparous patients without a short cervix or symptoms of sPTB. All patients included were delivered at term. Enrollment occurred between 18-24 weeks (V1) with follow up at 27-29 weeks (V2) and 33-35 weeks (V3). CVL was obtained using 3cc of normal saline placed on the anterior lip of the cervix and collected in the posterior fornix of the vagina after 30 seconds. Twenty-eight CVL biomarkers were analyzed via Luminex platform. Statistical analysis utilized t-test and Mann-Whitney test to compare groups between time points. 

Results: 32 patients were included. Three cytokines varied significantly over the second and third trimester: IL-3, a colony stimulating factor promoting differentiation and a progesterone-responsive cytokine; IL-17A, a product of IL-6 /TGFb transformed Th17 lymphocytes; and IL-15, a regulator of NK cell activity demonstrated statistically significant differences when comparing the three visits. The first two cytokines demonstrated similar patterns with increases in IL-3 and IL-17A at V2 and V3 compared to V1, See Figure 1. IL-15 was higher at V2 compared to V1 (p=0.036). Although these differences were statistically significant, the magnitude of the concentration change was modest using this methodology. 

Conclusion: Modulation in the immune system was seen during pregnancy in this low-risk cohort in the cervicovaginal space. These changes appear hormonally mediated, in part, and were primarily evident during the midtrimester. These data should be considered as baseline for interpretations of further research.