Predicting premature labour using the body’s natural defences

Our researchers have shown that women at risk of premature birth could be identified far sooner in pregnancy than current tests allow by looking for specific bacteria and chemicals in their vaginal fluid.
  • Authors list

    Professor Rachel Tribe, Sogol Salamipour, Dr Natalie Suff, Paul Seed, Professor Andrew Shennan

    Start date: 2014
    End date: 2021

  • Research centre

  • Research status

    Completed projects

Why do we need this research?

Premature birth can result in long-term health problems for the baby and is the leading cause of death in newborns. We need to find out more about why premature birth happens so that we can work out how to prevent it.

Previous research suggests that infection and inflammation can shorten and weaken the cervix (the neck of the womb), putting the baby at risk of infection and premature birth. Because of this, scientists are finding out whether there are any markers of infection and inflammation that can be used to identify women who are at increased risk of going into labour too soon. For example, they have been looking at substances called antimicrobial proteins – these are produced during pregnancy by cells in the vagina and cervix as the first defence against infection. In a small pilot study, Tommy’s researchers showed that one of these substances – elafin – was observed in higher amounts in women who gave birth before 37 weeks. Our researchers have been working to confirm these findings in a larger study and want to understand more about how this works.

What happened in this project?

Our researchers have been carrying out the INSIGHT study to find out more about the causes of premature birth. By looking at samples from over 600 women, including more than 400 who were at risk of premature birth, the team noticed that the amount of elafin in vaginal fluid drops during pregnancy. They also found that obese women and women who smoked during pregnancy had higher levels of elafin in their vaginal fluid.

Our researchers found a moderate link between elafin levels and the risk of premature birth before 34 weeks. However, when they looked at a different cohort of women from the INSIGHT study, they found that it may be possible to predict the chances of premature birth by looking at the levels of several different chemicals and bacteria in vaginal fluid, rather than just looking at elafin. They also identified a type of bacteria that has the potential as a probiotic treatment to reduce the risk of premature birth and further research is needed to find out more.

In another part of this project, Tommy’s researchers have been carrying out work in the lab to help them better understand the relationship between the types of bacteria that are present in the vagina and the levels of antimicrobial proteins such as elafin, and how this is linked to premature birth. In particular, they are beginning to understand that different bacteria have different effects on the lining of the vagina and that this relates to the risk of premature birth.

What difference will this project make?

This project has helped us understand more about how the body naturally responds to bacteria in the vagina, and how this might be linked to preterm labour. In particular, our researchers have found that it may be possible to identify mothers at risk of premature birth by analysing the levels of specific chemicals and bacteria in vaginal fluid. If infection and inflammation are found early, treatment may be possible, which would help to ensure that fewer babies are born too soon.

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