We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase- 8 were associated with subsequent preterm premature rupture of membranes. We conducted a case- control study examining 57 asymptomatic women who underwent genetic amniocentesis from 14 to 21 weeks’ gestation and subsequently had preterm premature rupture of membranes (< 35 wk) and 58 women with subsequent term delivery. Measurement of total matrix metalloproteinase- 8 level in amniotic fluid was conducted using a commercially available enzyme- linked immunosorbent assay and association with preterm birth due to preterm premature rupture of membranes was assessed. The overall distribution of matrix metalloproteinase- 8 concentrations was similar in women who had preterm premature rupture of membranes and term controls (median 2.39 ng/mL, 25th to 75th percentile 1.1- 10.1 vs 2.37 ng/mL, 25th to 75th percentile 1.5- 4.7, P =. 94). However, 26% of women who had preterm premature rupture of membranes had a matrix me- talloproteinase- 8 concentration above the 90th percentile (8.7 ng/mL), compared with only 10% of term controls (odds ratio 3.1, 95% CI 1.1- 8.7; P =. 03). Elevated matrix metallopro- teinase- 8 remained associated with preterm premature rupture of membranes after adjustment for maternal age, race, parity, gestational age, and year of amniocentesis (odds ratio 3.4, 95% CI 1.2- 9.9; P =. 03). The overall distribution of midtrimester amniotic fluid matrix metalloproteinase- 8 levels did not differ between women who had preterm premature rupture of membranes and those delivered at term. However, marked elevations of midtrimester amniotic fluid matrix metalloproteinase- 8 were highly associated with subsequent preterm premature rupture of membranes, suggesting that the pathophysiologic processes that contribute to preterm premature rupture of membranes may begin in early pregnancy.
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