Department of Social Medicine and Health Education, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China.
BMC Pregnancy Childbirth. 2023 Feb 21;23(1):123. doi: 10.1186/s12884-023-05445-4.
Systemic inflammation during pregnancy may be associated with preterm delivery (PTD), but data for twin gestations are lacking. The aim of this study was to examine the association of serum high-sensitivity C-reactive protein (hsCRP), a marker of inflammation, in early pregnancy of twin gestations with risk of PTD, including spontaneous (sPTD) and medical-induced preterm delivery (mPTD).
A prospective cohort study involved 618 twin gestations was conducted in a tertiary hospital in Beijing, from 2017 to 2020. Serum samples collected in early pregnancy were analyzed for hsCRP using particle-enhanced immunoturbidimetric method. Unadjusted and adjusted geometric means (GM) of hsCRP were estimated using linear regression, and compared between PTD before 37 weeks of gestation and term delivery at 37 or more weeks of gestation using Mann-Whitney rank sum test. The association between hsCRP tertiles and PTDs was estimated using logistic regression, and further converted overestimated odds ratios into relative risks (RR).
A total of 302 (48.87%) women were classified as PTD, with 166 sPTD and 136 mPTD. The adjusted GM of serum hsCRP was higher in PTDs (2.13 mg/L, 95% confidence interval [CI] 2.09 -2.16) compared to term deliveries (1.84 mg/L, 95% CI 1.80 -1.88) (P < 0.001). Compared with the lowest tertile of hsCRP, the highest tertile was associated with increased risk of PTD (adjusted relative risks [ARR] 1.42; 95% CI: 1.08-1.78). Among twin pregnancies, the adjusted association between high values of serum hsCRP in early pregnancy and preterm delivery was only observed in the subgroup of spontaneous preterm deliveries (ARR 1.49, 95%CI:1.08-1.93).
Elevated hsCRP in early pregnancy was associated with increased risk of PTD, particular the risk of sPTD in twin gestations.
孕期系统性炎症可能与早产（PTD）有关，但尚无关于双胞胎妊娠的数据。本研究旨在探讨双胞胎妊娠早期血清高敏 C 反应蛋白（hsCRP）作为炎症标志物与 PTD 风险的关系，包括自发性早产（sPTD）和医源性早产（mPTD）。
本前瞻性队列研究于 2017 年至 2020 年在北京一家三级医院进行，共纳入 618 例双胞胎妊娠。采用颗粒增强免疫比浊法分析早期妊娠血清 hsCRP。采用线性回归估计未调整和调整后的 hsCRP 几何均数（GM），并采用 Mann-Whitney 秩和检验比较 37 周前早产与 37 周及以上足月分娩的 GM 值。采用 logistic 回归估计 hsCRP 三分位与 PTDs 的关系，并将过高的优势比转换为相对风险（RR）。
共有 302 例（48.87%）孕妇被诊断为 PTD，其中 166 例为 sPTD，136 例为 mPTD。与足月分娩相比，PTD 组的 hsCRP 调整 GM 更高（2.13mg/L，95%置信区间 [CI]：2.09-2.16）（P<0.001）。与 hsCRP 最低三分位相比，最高三分位与 PTD 风险增加相关（调整后的相对风险 [ARR] 1.42；95%CI：1.08-1.78）。在双胞胎妊娠中，仅在自发性早产亚组中观察到早期妊娠 hsCRP 水平升高与早产之间存在调整后的关联（ARR 1.49，95%CI：1.08-1.93）。
早期妊娠 hsCRP 升高与 PTD 风险增加相关，尤其是双胞胎妊娠的 sPTD 风险增加。
