The anti-inflammatory limb of the immune response in preterm labor, intra-amniotic infection/inflammation and spontaneous parturition at term: A role for Interleukin-10.

Abstract

OBJECTIVE:

The anti-inflammatory limb of immune response is crucial for dampening inflammation. Spontaneous parturition at term and preterm labor are mediated by inflammation in the cervix, membranes and myometrium. This study focuses on the changes in the amniotic fluid concentrations of the anti-inflammatory cytokine IL-10. The objectives of this study were to determine whether there is a relationship between amniotic fluid concentrations of IL-10 and gestational age, parturition (at term and preterm) and intra-amniotic infection/inflammation (IAI).

STUDY DESIGN:

A cross-sectional study was conducted including 301 pregnant women in the following groups: 1) mid-trimester of pregnancy who delivered at term (n=112); 2) mid-trimester who delivered preterm neonates (n=30); 2) term not in labor, without intra-amniotic infection/inflammation (IAI) (n=40); 3) term in labor without IAI (n=24); 4) term in labor with IAI (n=20); 4) preterm labor (PTL) who delivered at term (n=31); 5) PTL without IAI, who delivered preterm (n=30); 6) PTL, with IAI, who delivered preterm (n=14). IL-10 concentrations in amniotic fluid were determined by a specific and sensitive immunoassay. Non-parametric statistics were used for analysis.

RESULTS:

1) IL-10 was detectable in amniotic fluid and its median concentration did not change with gestational age from mid-trimester to term; 2) Patients in labor at term, had a significantly higher median amniotic fluid IL-10 concentration than that of patients at term not in labor (p=0.04); 3) women at term in labor with IAI had a significantly higher median amniotic fluid IL-10 concentration than that of patients at term in labor without IAI (p=0.02); 4) women with PTL and IAI who delivered preterm had a significantly higher median amniotic fluid concentration of IL-10 than those without IAI who delivered preterm and than those who delivered at term (p=0.009 and p<0.001, respectively); 5) Among patients with preterm labor without IAI, those who delivered preterm had a significantly higher median amniotic fluid IL-10 concentration than those who delivered at term (p=0.03).

CONCLUSIONS:

The anti-inflammatory cytokine IL-10 is detectable in the amniotic fluid of normal pregnant women. Spontaneous parturition-at term and in preterm gestation is associated with increased amniotic fluid concentrations of IL-10. Intra-amniotic infection/inflammation (preterm and at term) is also associated with increased amniotic fluid concentrations of IL-10. We propose that IL-10 has a role in the regulation of the immune response in vivo by initiating actions which dampen inflammation.