Cervicovaginal metabolome may predict preterm birth

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Changes in the cervicovaginal (CV) metabolome may help predict which women are most at risk for preterm birth, new research suggests.

The CV biochemicals, amino acids, carbohydrates, and peptide metabolites differ in women with term vs preterm births, the study authors found.

"If we can identify the processes that are happening to the cervix weeks, if not months, prior to a preterm birth, whole new therapeutic strategies to prevent preterm birth can be entertained," senior author Dr. Michal A. Elovitz, of the University of Pennsylvania Perelman School of Medicine in Philadelphia told Reuters Health by email.

"(T)hese data challenge the current paradigm that preterm labor is simply labor occurring earlier in gestation," the authors reported online March 28 in the American Journal of Obstetrics & Gynecology.

Dr. Elovitz and her colleagues conducted a nested study using CV fluid from asymptomatic singleton-pregnant women enrolled in the PREDICT trial. The women were at high risk for preterm birth based on prior preterm birth or second-trimester loss, previous cervical surgery without subsequent full-term birth, and/or uterine anomaly.

To compare the metabolome of 10 women who would go on to have a spontaneous preterm birth with that of 10 women who would deliver at term, they collected the CV fluid at two visits and analyzed the biochemical profiles by gas chromatography/mass spectrometry and ultra-performance liquid chromatography/tandem mass spectrometry. The first visit was between 20 and 23 weeks and the second was between 24 and 27 weeks.

The authors identified 313 biochemicals in the CV fluid. In the first visit, 82 of them were different in the fluid of the women who would go on to have a preterm birth compared with a term birth. In the second visit, 48 of the biochemicals were different. The two groups showed differences in amino acid, carbohydrate, and peptide metabolites.

"Metabolomics has the potential to uncover novel mechanistic pathways involved in premature cervical remodeling and preterm birth," the researchers wrote.

"We did not know what to expect, as this type of profiling in the cervicovaginal space has never been done," Dr. Elovitz said. "We assumed that there would be some changes in the metabolome. It was unexpected to find them so early (weeks prior to a preterm birth)."

She added that many questions remain, including, "What causes the changes in the metabolome? Are the changes from the microbial communities in that space or from the host? Can we modify the changes seen to prevent the cervix from remodeling early?"

The Maternal and Child Health Research Fund at the University of Pennsylvania supported this research. The authors reported no conflicts of interest.

SOURCE: http://bit.ly/1EwxJoM

Am J Obstet Gynecol 2015.

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