Expression of IGF-1 in cervicovaginal secretions and its relationship with pregnancy outcomes in pregnant women with group B Streptococcus infection and premature rupture of membranes

Zhang Bihui; Zhu Xiaoning; Li Yan; Su Fang; Wei Xiaojing; Cao Caiping

doi:10.11986/j.issn.1673-873X.2024.11.11

Abstract：Objective To investigate the expression level of insulin-like growth factor-1(IGF-1)in cervicovaginal secretions and its correlation with pregnancy outcomes in pregnant women with Group B Streptococcus(GBS)infection and premature rupture of membranes(PROM).Methods A total of 600 pregnant women with GBS infection who underwent prenatal ex-aminations and delivered at Linfen People's Hospital from January 2019 to December 2023 were selected as the study group.Based on the occurrence of PROM,they were divided into a PROM group(145 cases)and a non-PROM group(455 cases).The PROM group was further categorized into a favorable outcome group(99 cases)and an adverse outcome group(46 ca-ses)based on pregnancy outcomes.Additionally,200 healthy pregnant women were selected as the control group.General data were collected,and levels of IGF-1 in cervicovaginal secretions,serum procalcitonin(PCT),and C-reactive protein(CRP)were measured.Logistic regression was used to analyze influencing factors for adverse pregnancy outcomes in GBS-infected PROM patients.Receiver operating characteristic(ROC)curves were employed to evaluate the predictive value of IGF-1 for adverse pregnancy outcomes.Results No statistically significant differences were observed between the study and control groups in age,body mass index(BMI),gestational weeks,parity,or gestational weight gain(P＞0.05).Similar-ly,no significant differences were found between the favorable and adverse outcome groups in age,BMI,gestational weeks,parity,co-occurrence of other vaginal infections,total labor duration,or gestational weight gain(P＞0.05).Serum PCT and CRP levels were significantly lower in the favorable outcome group than in the adverse outcome group(P＜0.05).IGF-1 levels in cervicovaginal secretions were significantly lower in both the PROM and non-PROM groups compared to the con-trol group,while serum PCT and CRP levels were significantly higher(P＜0.05).The PROM group had significantly low-er IGF-1 levels and higher PCT and CRP levels than the non-PROM group(P＜0.05).IGF-1 levels were significantly high-er in the favorable outcome group than in the adverse outcome group(P＜0.05).Multivariate logistic regression revealed that cervicovaginal IGF-1 was a protective factor against adverse pregnancy outcomes,while scrum PCT and CRP were risk factors(P＜0.05).The area under the ROC curve(AUC)for predicting adverse pregnancy outcomes using cervicovaginal IGF-1,serum PCT,and CRP was 0.949(95％CI:0.906-0.982),0.942(95％CI:0.891-0.974),and 0.960(95％CI:0.914-0.986),respectively.The combined AUC of all three markers was 0.991(95％CI:0.959-0.999),which was higher than individual predictions(ZIGF-1-combined=2.828,P=0.005;ZPCT-combined=2.038,P=0.042;ZCRP-combined=2.492,P=0.013).Conclusion Reduced IGF-1 levels in cervicovaginal secretions of GBS-infected PROM patients are closely associated with adverse pregnancy outcomes and demonstrate high predictive value.Clinically,monitoring IGF-1 lev-els closely may aid in early assessment of pregnancy outcomes in this population.