Predicting premature labour using the body’s natural defences

Dr Rachel Tribe, Mr Paul Seed, Dr Evonne Chin-Smith, Dr Natasha Hezelgrave, Dr Evonne Chin Smith, Prof Andrew Shennan, Dr Alex Ridout, Dr Helena Watson, Dr James Mason, Tokuwa Kanno, Prof William Wade, Dr Carlos Gallo

Researchers funded by Tommy’s have found that a natural substance made by cells in the vagina and cervix could be used to tell whether a woman will go into early labour.

Tommy's is always looking for new ways to lower the risk of early labour. This is because premature birth is the leading cause of death in the days shortly after a baby is born. Recently, we helped fund a study into how we could use elafin, a natural substance in the body, to tell if a woman is likely to go into premature labour.

During pregnancy, cells in the walls of the vagina and cervix produce substances that help to fight bacteria and other micro-organisms. These can be “switched on” when a harmful micro-organism is present. Our researchers tested whether one of these substances, elafin, could be used to tell whether or not early labour will take place. So far, over 700 women have taken part in the study. Around half of these women were at high risk of early labour, based on their clinical history.

To look at how elafin could affect early labour, doctors took samples of vaginal fluid, blood, and cells at different stages during the pregnancy. Scientists then looked at the cells to see how much elafin was made normally, and compared this to how much was made when the cells were exposed to different conditions.

Scientists studied cells taken from high in the women's vaginas and cervixes. They found that there was more elafin present in women who went on to develop a short cervix, or who went into early labour. The reason for this was due to a small change in the gene that makes elafin: women with this change made more elafin than others. The length of the cervix is important: during pregnancy, the cervix changes shape because of the baby growing inside the womb. If gets too short, it is more likely that a woman will go into premature labour.

The results suggest that this could be a promising way of warning women and doctors early on of the likelihood of premature labour. The earlier we know this, the more we can do to give the baby the best chance of surviving.

These results then led to a large programme of work to further understand the role of elafin and vaginal bacteria in premature labour. 

They have identified one vaginal bacteria species that when deficient, is linked to preterm birth. They have also, for the first time, investigated how the bacteria in the vagina can influence important “metabolites.” By measuring these “metabolites” – small molecules that are produced when substances in the body break down to create energy - we may be able to tell if there is abnormal bacterial activity in the vagina.  

So far, researchers have found marked differences in the bacterial profiles of women who delivered their baby preterm and women who delivered at term. Cervico-vaginal fluid (CVF) samples taken from women who later had a preterm birth, showed increased bacterial diversity compared to CVF from women who went on to deliver at term. 

This research is continuing throughout 2018, with researchers aiming to study over 2,000 women at risk of early labour. 

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This study takes place in a Tommy's centre and is funded by Tommy's, the National Institute for Health Research, the Rosetrees' Project Grant, the British Maternal and Fetal Medicine Society, Guy's and St Thomas' Biomedical Research Centre, and Wellbeing of Women

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