Correlation of levels of serum C reactive protein in second trimester with fetomaternal outcome

Authors

  • Koppadi Lakshmi Vijetha Department of Obstetrics and Gynecology, Rajiv Gandhi Government Women and Children Hospital, Puducherry, India
  • P. Sujatha Department of Obstetrics and Gynecology, Rajiv Gandhi Government Women and Children Hospital, Puducherry, India
  • Nina V. Kate Department of Obstetrics and Gynecology, Rajiv Gandhi Government Women and Children Hospital, Puducherry, India
  • Usha Vaithiyanadhan Department of Pediatrics, Rajiv Gandhi Government Women and Children Hospital, Puducherry, India
  • Vani Gopal Department of Microbiology, Rajiv Gandhi Government Women and Children Hospital, Puducherry, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20220570

Keywords:

C- reactive protein, Preterm labour, PROM, Low APGAR

Abstract

Background: The aim of the study was to evaluate the association between levels of second trimester C Reactive protein (CRP) with adverse pregnancy outcomes.

Methods: Present study was a prospective analytical study carried out among 359 pregnant women between 14-18 weeks. All were primigravida, who attended antenatal OPD at RGGWCH between January 2019 to June 2020. All subjects fulfilled inclusion and exclusion criteria. Informed written consent was obtained in each case. A detailed history, clinical and ultrasound examination was done to confirm the gestational age. Then blood was collected and sent for serum CRP estimation. Patients were followed upto discharge of the mother and baby and fetomaternal outcome studied. Once the sample size was attained, the correlation between CRP levels and fetomaternal outcome was studied.

 Results: Increased levels of serum CRP in early second trimester in primigravida were significantly associated with adverse pregnancy outcomes like preterm delivery (p value 0.001), PROM (premature rupture of membranes) (p value 0.01) and low APGAR (p value 0.01).

Conclusions: Early detection of higher levels of serum CRP in pregnancy can be used as predictor of inflammation and may help in early intervention, follow up and timely referral of the patients to minimize adverse maternal and fetal complications.

 

References

Ananthanarayan R, Paniker C. Ananthanarayan and Paniker's Textbook of Microbiology (7th ed.). Himayatnagar, Hyderabad: Orient Longman. 1978;218.

Tillett WS, Francis T. Serological reactions in pneumonia with a nonprotein somatic fraction of pneumococcus. The Journal of Experimental Medicine. 1930;52(4):561.

Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW. C - reactive protein in healthy subjects: Associations with obesity, insulin resistance, and endothelial dysfunction: A potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol. 1999;19:972-78.

Waranuch P, Matthew W, Gillman, Kaumudi J, Joshipura, Paige et al. Plasma CRP in early pregnancy & preterm delivery. Am J Epidemiology. 2005;162(11):1108-13.

Hwang HS, Kwon JY, Kim MA, Park YW, Kim YH. Maternal serum HSCRP in normal pregnancy and pre-eclampsia. Int J Gynaecol Obst. 2007;98:105-ma09.

Cox SM. Preterm labour. In: Cunningham FG, Steven L. Bloom, Leveno KJ (eds) Williams Obstetrics, 22nd Edn: McGrawhill. 2001;860.

Lockwood CJ, Kuczynski E. Markers of risk for preterm delivery. J Perinat Med. 1999;27:5-20.

Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000;342:1500-7.

Bauman MD, Losif AM, Smith SE, Bregere C, Amaral DG, Patterson PH. Activation of the maternal immune system during pregnancy alters behavioral development of rhesus monkey offspring. Biol Psychiatry. 2014;75:332-41.

Patterson PH. Maternal infection and autism. Brain BehavImmun. 2012;26:393.

Smith SE, Li J, Garbett K, Mirnics K, Patterson PH. Maternal immune activation alters fetal brain development through interleukin-6. J Neurosci. 2007;27:10695-702.

Atladottir HO, Henriksen TB, Schendel DE, Parner. Autism after infection, febrile episodes, and antibiotic use during pregnancy: an exploratory study. Pediatrics. 2012;130:e1447-54.

Zerbo O, Iosif AM, Walker C, Ozonoff S, Hansen RL, Hertz-Picciotto I. Is maternal influenza or fever during pregnancy associated with autism or developmental delays? Results from the CHARGE (CHildhood Autism Risks from Genetics and Environment) study. J Autism Dev Disord. 2013;43:25-33.

Drake AJ, Reynolds RM. Impact of maternal obesity on offspring obesity and cardiometabolic disease risk. Reproduction. 2010;140:387-98.

Denison FC, K A Roberts, S M Barr, J E Norman. Obesity, pregnancy, inflammation, and vascular function. Reproduction. 2010;140:373-85.

Visser M, Bouter LM, Geraldine M, Mark H, Tamara B. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282:2131-5.

Davi G, Patrono C. Platelet activation in obese women: role of inflammation and oxidant stress. JAMA. 2002;288:2008-14.

Ramsay JE, Ferrel WR, Crawford L, Wallace AM, Greer IA, Sattar N. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J ClinEndocrinol Metab. 2002;87:4231-37.

Rusterholz C, Grill S, Rosanna ZD, Sevgi T, Wolfgang H, Sinuhe H et al. Role of placentally produced inflammatory and regulatory cytokines in pregnancy and the etiology of preeclampsia. Semin Immunopathol. 2007;29:151-62.

Challier JC, S Basu, S Hauguel de Mouzon. Obesity in pregnancy stimulates macrophage accumulation and inflammation in the placenta. Placenta. 2008;29:274-81.

Radaelli T. Gestational diabetes induces placental genes for chronic stress and inflammatory pathways. Diabetes. 2003;52:2951-8.

Stewart FM, Freeman DJ, Ramsay JE, Greer IA, Caslake M, Ferrell WR. Longitudinal assessment of maternal endothelial function and markers of inflammation and placental function throughout pregnancy in lean and obese mothers. J Clin Endocrinol Metab. 2007;92:969-75.

Sen S, Simmons RA. Maternal antioxidant supplementation prevents adiposity in the offspring of Western diet-fed rats. Diabetes. 2010;59:3058-65.

Nakishbandy BMN, Sabat A, Barawi M. Level of c- reactive protein as an indicator for prognosis of premature uterine contractions. Journal of prenatal Medicine. 2014;8(1/2):25-30.

E Teran, Escudero C, Moya W, Flores M, Vallance P, Jaramillo LP. C reactive protein during normal pregnancy and preeclampsia. International journal of gynecology and obstetrics. 2005;89:299-300.

Nikbakht R, Karimi E, Moghadam, Zeinab Nasirkhani. Maternal serum levels of C – reactive protein at early pregnancy to predict fetal growth restriction and preterm delivery: A prospective cohort study, Int J Reprod BioMed. 2020;18:157-64.

Dhamayanthi. Measurement of serum C- reactive protein levels in early second trimester as a predictor of preterm delivery. Institute of obstetrics and gynecology.

Ernst GDS, De Jonge LL, Hofman A. C – reactive protein levels in early pregnancy, fetal growth patterns, and risk for neonatal complications: the generation R study. American Journal of Obstetrics and Gynecology. 2011;205(132):e1-8.

Kumara V, Singh S, Chaursia A. Predictive value of C- reactive protein levels during pregnancy in adverse pregnancy outcome. Indian Journal of Obstetrics and Gynecology Research. 2018;5(4):500-3.

Dhok AJ, Daf S, Mohodn K, Kumar S. Role of early second trimester high sensitivity C- reactive protein for prediction of adverse pregnancy outcome. JK science. 2011;13:3.

Rout RR, Mahalik M. Comparision of C- reactive proteins level in gestational hypertension and in normal pregnancy in 2nd and 3rd trimester and its correlation with maternal and foetal outcome. Int J Reprod Contracept Obstet Gynecol. 2019;8(6):25418.

Mojibian M, Soheilykhan S, Saghand RS, Rashidi M. Maternal serum C- reactive protein concentration in gestational diabetes. Iranian journal of diabetes and obesity. 2011;3(2):212-6.

Qiu C, Sorensen TK, Luthy DA, Williams MA. A prospective study of maternal serum C reactive protein concentrations and risk of gestational diabetes mellitus. Paediatric and perinatal epidemiology. 2004;18(5):377-84.

Leipold H, Worda C, Gruber CJ, Prikoszovich T, Wagner O, Willer KA. Gestational diabetes mellitus is associated with increased C reactive protein concentrations in the third but not second trimester. European journal of clinical investigation. 2005;36(12):752-7.

Hvilsom GB, Thorsen P, Jeune B, Bakketeig LS. C - reactive protein: a serological marker for preterm delivery? Acta Obstet Gynecol Scand. 2002;81:424-29.

Tjoa ML, Van Vugt JM, Go AT, Blankenstein MA, Oudejans CB, Van Wijk IJ. Elevatsed C- reactive protein levels during first trimester of pregnancy are indicative of preeclampsia and intrauterine growth restriction. J Reprod Immunol. 2003;59:29-37.

Gaillard R, Santos S, Duijts L, Felix J.F. Maternal inflammation during pregnancy and childhood adiposity. Obesity. 2016;4(24):1320-7.

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Published

2022-02-25

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Original Research Articles