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Factors for Pre-Term Birth - transcript
From 23rd Annual Society for Maternal-Fetal
Medicine (SMFM) Conference held in San Francisco, California - February
2003
Factors for Pre-Term Birth
Amy Murtha, MD interviewed by Hans van der Slikke, MD, PhD
Hans van der Slikke, MD, PhD:
“It’s February 6, 2003. We are in San Francisco at the meeting of the Maternal Fetal Medicine Society and next to me is Amy Murtha – Welcome! - from Duke University. Yesterday you had a beautiful presentation about the role inflammation can play in pre-term labour and the other thing you added to it was that maybe prematurity is a kind of genetic complex.”
Amy Murtha, MD: “I think, as many of us are well aware, inflammation has been studied extensively with relationship to pre-term birth. It’s been well-established that in patients with pre-term labour and pre-term premature rupture of membranes that various inflammatory mediators, including interleukin-6 and interleukin-1 and tumour necrosis factor are all elevated in compartments, including maternal serum, in the amniotic fluid, foetal cord blood, so on and so forth, vaginal and cervical secretions, and so we know that inflammation is an important part of pre-term birth.
What we spoke about yesterday was that in many other systemic inflammatory diseases; things like lupus, rheumatoid arthritis, cardiovascular disease, and in the transplant literature, there’s been much work to look at various genetic polymorphisms in these inflammatory mediators that we’ve reviewed in the obstetric literature. We are, in obstetrics, just really at the beginning part of looking at some of these polymorphisms and trying to identify whether or not they are significant and what potentially put people at a higher genetic predisposition for pre-term birth.”
Hans van der Slikke, MD, PhD: “You also talked about the tests you did with women who delivered prematurely a long time ago.”
Amy Murtha, MD: “There was a cohort study where they looked at linked databases from two generations, and they looked at women that had been pre-term deliveries themselves and then what happened during their pregnancies if we had a mom who had been a pre-term birth herself, she had a significantly higher risk of having a pre-term baby, and that was even more significant if her pre-term birth had been less than thirty weeks. So it suggested again that there might be some genetic predisposition, something, a difference, and an inheritable trait that would put that woman at risk for pre-term birth.”
Hans van der Slikke, MD, PhD: “And could you think about which mechanism that could be?”
Amy Murtha, MD: “I think probably one of the most important things for us to keep in mind is that this system is incredibly complex and while we pick off various polymorphisms, and many investigators are doing that, it’s likely not going to be one particular cytokine polymorphism that’s going to explain the whole thing. The inflammatory process is very complex on many levels with many interactions that affect other interactions and so forth. In addition to that, there’s environmental exposures, things like smoking, nutritional status, those sorts of things, substance abuse, that may alter your ability to respond to those stimuli and you may, your inflammatory response may be different based on what your environmental exposures are and based on what your genetic predisposition is. So I think, the message is, it’s not going to be simple, but it certainly is something that needs to be pursued in a very aggressive way.”
Hans van der Slikke, MD, PhD: “So your main message may be, as well, it could be that it’s not only just like normal life, it’s not only your genetic factors, but it’s your environment as well.”
Amy Murtha, MD: “Absolutely. Absolutely.”
Hans van der Slikke, MD, PhD: “Thank you very much.”
Amy Murtha, MD: “Thank you.”
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