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clinmed/2002050001v1 (May 16, 2002)
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The influence of prelabor rupture of the membranes (PROM) on levels of oral mucosal immunoglobulins in the neonate

 

Key words:

FSC, IgD, neonate, PROM, sIgA

 

Abstract:

Oral mucosal immunoglobulins play an important role in the human immune system as a first line defence against viral and bacterial infection. Secretory IgA, IgD and the free secretory component can be determined in the first days of life, however it is yet unknown which events influence the local synthesis of the immunoglobulins.

The aim of this study was to evaluate the influence of prelabor rupture of the membranes (PROM) within a period of 24 hours on synthesis of oral mucosal sIgA, IgD, FSC and albumin of neonates in their first day of life.

Comparison of 21 neonates with a history of PROM with a control group of 44 term neonates revealed no significant differences neither with respect to sIgA, IgD, FSC nor to albumin.

The results indicate that PROM within a period of 24 hours does not significantly increase the synthesis of oral mucosal immunoglobulins in neonates in the first day of life.

 

Introduction:

Oral mucosal immunoglobulins play an important role in the human immune system as a first line defence against viral and bacterial infection. The predominant immunoglobulin is secretory IgA (sIgA) with its secretory component (SC) leading to partial resistance to proteolysis. In saliva sIgA coexists with IgD, its function, however, is not well understood yet. Both immunoglobulins as well as the free secretory component (FSC) can be determined in saliva of neonates shortly after birth [1, 2]. Nevertheless it is rather unknown which events influence the levels of sIgA, IgD and FSC in saliva of neonates in their first day of life. Exposing mucosal membranes to antigens results in increased local synthesis of sIgA and IgD antibodies. Prelabor rupture of the membranes (PROM) is often associated with contact to antigens leading to fetal infection even when the interval between membrane rupture and beginning of active labor is shorter than 24 hours. However, on many occasions these infections are not clinically apparent in the neonate shortly after birth. This cross-sectional study was designed to evaluate the influence of prelabor rupture of the membranes on synthesis of oral mucosal sIgA, IgD, FSC and albumin of neonates in their first day of life.

 

Materials and Methods:

A total of 21 neonates (37 to 40 weeks of gestation) with a history of membrane rupture up to 24 hours before the beginning of active labor were investigated for levels of sIgA, IgD, FSC and albumin in unstimulated saliva. A randomly selected group of 44 term neonates without a history of PROM served as control. Exclusion criteria were: Signs of malformation, APGAR score <7 after 1, 5 or 10 minutes, postprandial time before collection of saliva <60 min, saliva volume <30 µl and saliva pH <6 as well as a history of abruption, vaginal bleeding or infection of their mothers. Comparison of groups included age, gender, birth weight, saliva pH, saliva flow, placenta weight, duration of active labor as well as the interval between membrane rupture and the beginning of active labor (table 1).

 

To collect unstimulated saliva from the bottom of the mouth and the buccal sulci a sterile polyethylene tube connected to a syringe was used. Care was taken to avoid oral stimulation leading to an increase in saliva flow and trauma to the mucosa that could result in oral bleedings. The concentrations of sIgA and IgD, FSC and albumin were measured by radial immunodiffusion (RID) following the instruction of the manufacturer (The Binding Site Ltd., Birmingham, U.K.). Statistical differences between both groups were tested using the Mann-Whitney U-Test accepting values of p <0.05 as statistically significant.

 

Results:

Neonates in the PROM group showed higher levels of sIgA, FSC and albumin, whereas IgD was found to be lower compared with controls. However, differences failed to reach statistical significance (table 1). Additionally, subdivision of the subjects into groups with different intervals between rupture of the membranes and the beginning of active labor (Group A: up to 6 hours, group B: 6 to 24 hours) did not reveal any significant differences neither with respect to levels of sIgA (p=0.073) nor to IgD (p=0.958), FSC (p=0.385) or albumin (p=0.412).

 

 

Table 1: Biochemical and clinical data of the study population.

            CI: Confidence interval.

 

 

 

PROM group (n = 21)

Control group (n = 44)

 

 

 

Mean

95% CI

Mean

95% CI

P

sIgA

mg/l

234.1

99.5 - 368.7

174.6

96.3 - 252.9

0.319

IgD

mg/l

1.73

1.0 - 2.4

3.3

2.1 - 4.6

0.232

FSC

mg/l

10.7

7.8 - 13.5

9.9

7.5 - 12.2

0.299

Albumin

mg/l

35.0

18.9 - 51.1

20.8

12.1 - 29.5

0.058

Duration of active labor

min

271.3

211.1 - 331.6

290.1

257.3 - 323.0

0.617

Interval between membrane rupture and beginning of active labor

min

569.8

473.5 - 666.1

69.0

39.5 - 98.5

< 0.001

 

 

Discussion:

Whereas quantification of immunoglobulins in the chorioamniotic membranes as well as in cord blood is performed to evaluate the risk of developing subclinical or clinical infection in the neonate shortly after birth [3, 4], there is only scarce information available about immunoglobulins in the neonate’s saliva although the oral mucosal immune system is the first barrier for antigens in early infancy. We speculated that increased levels of mucosal immunoglobulins would be determined in neonates with a history of PROM even within a period of 24 hours. However, despite limitations due to the small study population, our study showed that prelabor rupture of the membranes within a period of 24 hours before the beginning of active labor does not significantly increase the syntheses of sIgA, IgD, FSC or albumin in the first day of life. Nevertheless further studies are required to evaluate the neonate’s mucosal immune response in a period >24 hours between membrane rupture and the beginning of active labor.

 

References:

[1] Friedmann MG, Entin N, Zedaka R, Dagan R: Subclasses of IgA antibodies in serum and saliva samples of newborns and infants immunized against rotavirus. Clin Exp Immunol 103 (1996) 206-211.

[2] Gleeson M, Cripps AW, Clancy RL: Modifiers of the human mucosal immune system. Immunol Cell Biol 73 (1995) 397-404.

[3] Berezoswski AT, Cunha SP, Da Costa JC, Bacchi CE: Quantification of immunoglobulin A in chorioamniotic membrane of patients with premature rupture of membranes. Int J Gynaecol Obstet 47 (1994) 23-26.

[4] Mahulja-Stamenkovic V, Beleznay O, Stamenkovic M, Samardzija R, Makis J: IgG, IgM and IgA umbilical cord concentrations in normal singleton vaginal deliveries with stinking amniotic fluid or intrapartal maternal febrility ³ 38°C or duration of delivery > 12 hours. Zentralbl Gynakol 115 (1993) 33-35.

 





This Article
Right arrow Abstract Freely available
Services
Right arrow Similar articles in this netprints
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Seidel, B. M.
Right arrow Articles by Borte, M.
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PubMed
Right arrow Articles by Seidel, B. M.
Right arrow Articles by Borte, M.
Related Collections
Right arrow Immunology:
Other immunology

Right arrow Obstetrics and Gynaecology:
Reproductive medicine

Right arrow Pregnancy


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