Higher admission CRP levels are associated with histological chorioamnionitis in patients with PPROMHigher C-reactive protein levels linked to infection in pregnancy

Frontiers in Medicine Published September 28, 2026 DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Note that higher admission CRP levels associate with histological chorioamnionitis, but clinical utility is limited by heterogeneity.

This meta-analysis evaluated the association between admission C-reactive protein (CRP) levels and histological chorioamnionitis (HCA) in 1,791 patients with preterm premature rupture of membranes (PPROM). The analysis found that patients who developed HCA had higher admission CRP levels (MD = 0.439; 95% CI: 0.179 to 0.700).

The authors note that the study design is observational, meaning the results indicate an association rather than a direct cause. Furthermore, the analysis was characterized by substantial heterogeneity (I2 = 87.7%) and a small effect size. These factors, combined with the observational nature of the included studies, necessitate caution when interpreting the strength of the association.

Clinically, CRP may serve as an auxiliary indicator to assist in early risk stratification for HCA. However, its utility as a primary diagnostic tool is limited by the observed heterogeneity and the small magnitude of the effect. Practitioners should consider these limitations when integrating CRP levels into clinical decision-making for PPROM management.

How this fits prior evidence

This finding addresses a gap in identifying biomarkers for risk stratification in PPROM. While previous evidence established that ampicillin-gentamicin reduces chorioamnionitis risk to 1.9% compared to 10.6% with ampicillin alone, this meta-analysis explores the role of CRP as an auxiliary indicator. It does not directly relate to the use of N-acetylcysteine for neonatal morbidity, the management of polymicrobial infections with meropenem and norepinephrine, or the maternal infection risks associated with repeat corticosteroids.

When a woman's membranes rupture too early during pregnancy, the risk of infection becomes a major concern for both the mother and the baby. Doctors look for ways to identify these infections early to provide better care. This study looked at how C-reactive protein, or CRP, levels in the blood relate to a specific type of infection called chorioamnionitis.

Researchers looked at data from 1,791 patients. They found that women who developed the infection had higher CRP levels at the time of admission. While this suggests that CRP could be a helpful extra tool for doctors to spot risks early, the difference was small. Because the study was based on observations rather than a controlled trial, it shows a link rather than a direct cause.

It is important to note that the results were quite varied across different studies. Because of this inconsistency and the small size of the effect, doctors should not use CRP as the main way to diagnose infection. It is currently seen as a helpful extra indicator rather than a primary test.

What this means for you:

Higher CRP levels are linked to infection in pregnancy, but the link is small and varies between cases.

Common questions

What is C-reactive protein and how does it relate to pregnancy?

C-reactive protein, or CRP, is a protein that increases in the body when there is inflammation or infection. In this study, researchers looked at CRP levels to see if they could help identify a specific infection called chorioamnionitis in women whose membranes ruptured too early during pregnancy.

Can CRP levels be used to diagnose infection in pregnancy?

CRP may serve as an extra tool to help doctors identify risks early. However, because the effect size was small and the results varied greatly between studies, it is not currently used as a primary way to diagnose infection. It is an additional indicator rather than a main diagnostic test.

Is the link between CRP and infection certain?

The study found a link between higher CRP levels and infection, but it does not prove that CRP causes the infection. Because the data came from observational studies, it shows an association. Additionally, high levels of variation in the data mean doctors should be cautious when interpreting these results.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedSep 2026

View Original Abstract ↓

BackgroundPreterm premature rupture of membranes (PPROM) is a high-risk obstetric complication. Ascending infection and histological chorioamnionitis (HCA) frequently occur after membrane rupture, contributing to severe adverse maternal and fetal outcomes. Early prediction of HCA using non-invasive biomarkers allows timely clinical management, while the predictive efficacy of C-reactive protein (CRP) for subsequent HCA in PPROM patients remains inconsistent across existing studies. This meta-analysis aimed to systematically evaluate the predictive association.MethodsWe systematically searched PubMed, Scopus, Web of Science and the Cochrane Library from inception to May 20, 2026 for studies on serum CRP and subsequent HCA in PPROM patients. Pooled mean differences (MD) of admission CRP concentrations were calculated using random-effects meta-analysis with results visualized via forest plots. Leave-one-out sensitivity analysis confirmed robustness. Subgroup analyses and meta-regression were applied to explore potential sources of heterogeneity. Funnel plots, combined with Egger's test and Begg's test, were used to evaluate publication bias. All statistical analyses were conducted using R software (version 4.6.0).ResultsInitially, 11 studies were screened. After excluding one low-quality study, 10 studies (1,791 participants) were ultimately included. The pooled results demonstrated that PPROM patients who subsequently developed HCA exhibited higher admission CRP levels than non-HCA controls (MD = 0.439, 95% CI: 0.179–0.700), with substantial heterogeneity (I2 = 87.7%). Meta-regression and subgroup exploration suggested sample size may partially drive cross-study heterogeneity; this moderator accounted for 31.19% of total variance, with a borderline significant association (P = 0.05). Sensitivity analysis confirmed the stability of the pooled estimates. Egger's test revealed no significant publication bias (P > 0.05), but the substantial heterogeneity warrants caution in interpretation.ConclusionThis meta-analysis suggests that elevated admission CRP levels are modestly correlated with subsequent HCA in PPROM populations. CRP may serve as an auxiliary indicator to assist early risk stratification; however, its clinical utility is limited by the small effect size and substantial heterogeneity across studies. Given the observational design of the included studies, these findings represent association rather than causation. Prospective cohort studies with standardized protocols are needed to confirm these results and assess the incremental value of CRP over existing clinical predictors.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261404654.

Higher admission CRP levels are associated with histological chorioamnionitis in patients with PPROMHigher C-reactive protein levels linked to infection in pregnancy

How this fits prior evidence

Common questions

Study Details

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Higher admission CRP levels are associated with histological chorioamnionitis in patients with PPROMHigher C-reactive protein levels linked to infection in pregnancy

How this fits prior evidence

Common questions

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