519: The effect of 17-alpha hydroxyprogesterone caproate (17P) on the midtrimester, proinflammatory milieu of the human cervix

caproate (17P) on the midtrimester, proinflammatory milieu of the human cervix Renata Wilczek, Frank Schubert, Debra Hoppensteadt, John Gianopoulos, Richard Besinger, Josephine Cunanan, Robert Mittendorf Indiana University School of Medicine, Obstetrics and Gynecology, Indianapolis, IN, Loyola University Chicago, Department of Pathology, Maywood, IL, Northwestern University Feinberg School of Medicine, Obstetrics and Gynecology, Chicago, IL, Loyola University Health System, Obstetrics and Gynecology, Maywood, IL OBJECTIVE: In our study, we tested the hypothesis that 17P, used for prevention of recurrent preterm birth in singleton gestations, decreases the midtrimester levels of cervical mucus proinflammatory cytokines. A secondary goal was to compare cytokine concentrations in women with and without a history of preterm birth, as well as in 17P responders (term delivery) and nonresponders (preterm delivery). STUDY DESIGN: We conducted a prospective cohort study. Cervical mucus was obtained aseptically at approximately 16 weeks gestation from women with (cases, n 31) and without (controls, n 16) a history of preterm birth. Specimen collection was repeated after four weekly injections of 17P in the case group and at a similar gestational age in the control group. Concentrations of TNF, IL-1 , IL-1 , IL-6, IL-8 and INFwere determined (ELISA). RESULTS: Among cases, no significant changes in cytokine levels occurred after the initiation of 17P (Figure 1). Similarly, no significant changes were noted in the control group when comparing samples obtained at two different time points. Of interest, the baseline concentrations of IL-8 and TNFwere lower in the case group as compared to the controls (IL-8 148 pg/ml vs. 481 pg/ml, [P .03]; TNF50 pg/ml vs. 300 pg/ml, [P .002]). Median TNFlevels remained lower in women with a history of preterm birth despite the initiation of 17P (56 pg/ml vs. 455 pg/ml in the control group, [P .02]). The concentrations of IL-6 and INFremained stable after a month of 17P, but their late midtrimester values were significantly higher as compared to the control group at a similar gestational age (IL-6 47 pg/ml vs. 21 pg/ml, [P .04]; INF45 pg/ml vs. 16 pg/ml, [P .01]). Table 1 shows the data for 17P responders and nonresponders. Of interest, a significant difference was observed for INF. The difference (delta, ) in its level was greater among 17P nonresponders. CONCLUSION: Our current data, preliminary in nature, do not actively support the hypothesis of an immunomodulating role for 17P in the prevention of recurrent preterm birth. 520 Antenatal depressive symptoms increase the likelihood of preterm birth Richard Silver, Marci Adams, Heather Straub, Jo Kim NorthShore University HealthSystem, Department of Obstetrics and Gynecology, Evanston, IL OBJECTIVE: The purpose of this study was to evaluate the relationship between antenatal depressive symptoms and subsequent preterm birth. STUDY DESIGN: After completing the Edinburgh Postnatal Depression Scale (EPDS) between 24-28 weeks’ gestation, patients were followed prospectively. An EPDS score 12 (or endorsement of thoughts of self-harm) indicated a symptomatic woman at-risk for depression. All symptomatic patients received standardized telephonic assessment for diagnostic evaluation and triage from trained licensed mental health workers. Symptomatic women were compared to risk-negative cases for relevant demographic, historical and pregnancy outcome variables. RESULTS: Between 1/1/03 and 3/31/11, prenatal EPDS were administered to 14,175 women resulting in a screen-positive rate of 9.1% (n 1,298). Symptomatic patients were older (p 0.001), more often parous (p 0.03), overrepresented by minorities (African American and Hispanic; p 0.001) and more likely uninsured or on Medicaid (p 0.001). Prior preterm birth was also more common among symptomatic women compared to risk-negative cases (21.3% versus 13.7%; p 0.001). In the current pregnancy, the symptomatic cohort had a significant increase in preterm birth at 37 weeks’ gestation (13.9% versus 10.3%; p 0.001). Higher preterm birth percentages were also seen at 34 week and 32 week breakpoints (p 0.01 and p 0.05). Multivariable analysis adjusting for maternal age, race/ethnicity, prior preterm delivery, and insurance status revealed a persistent association between antenatal depressive symptoms and preterm birth (OR 1.3, 95% CI 1.09-1.35). There was also an increased proportion of SGA infants (birth weight 10%tile) among symptomatic women compared to risk-negative patients (6.6% vs. 5.1%, p 0.001). CONCLUSION: In this large cohort of prenatally screened women, those with depressive symptoms had an increased likelihood of preterm birth. There are plausible biologic linkages between these conditions and it is intriguing to speculate on the effect, if any, that therapeutic interventions for depression might have on this critical obstetric outcome. www.AJOG.org Doppler Assessment, Fetus, Prematurity Poster Session III