An IRB approved prospective, cohort study including pregnant women at 11-16 weeks gestation, >18 years of age, and carrying a singleton pregnancy conducted from June 2016 to August 2017. Women with a history of prior spontaneous preterm birth and eligible for intramuscular progesterone were compared with healthy, uncomplicated pregnancies. Excluded were women with vaginitis, diabetes mellitus, hypertension, or other chronic diseases affecting the immune response. A sterile vaginal washing was performed and collected at enrollment between 11-16 weeks gestation. Samples underwent semi-quantitative detection of human inflammatory markers (MMP) and tissue inhibitors of MMPs (TIMP). Immunofluorescence pixel density data was analyzed and a p-value < 0.05 was considered significant. RESULTS: There were 48 women included, 16 with a prior spontaneous preterm birth and 32 healthy controls. The baseline demographics and pregnancy outcomes for both groups were similar in age, parity, race, and BMI. The metalloproteinase comparison can be seen in Figure 1. The vaginal MMP-9 value was significantly greater in the high-risk group than in the control group (integrative density 74.94 AE 27.04% vs 49.38 AE 31.08%, p¼0.009). The ratio of MMP-9:TIMP-1 was also 1.8 times higher in the high-risk group than in the control group (integrated density 2.17 AE 2.78% vs 1.21 AE 1.09%, p¼0.099). The ratio of MMP-8:TIMP-2 was similar between the groups. CONCLUSION: There is an increased MMP presence in vaginal washings of women at high-risk for preterm birth compared to healthy controls. Vaginal MMP-9 may have potential as a marker for predicting preterm birth.

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and higher QALYs. Sensitivity analyses showed our model was robust over a wide range of assumptions. CONCLUSION: Among pregnant women in the United States, universal HCV testing is cost effective based on wholesale cost estimates of direct acting antivirals (DAA) as a curative treatment. While treatment of HCV must currently take place postpartum, the ability to capture and link women to care should be utilized to allow greater usage of curative treatment regimens.

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