Cytokines in the perinatal period – Part I

•Pregnancy is an immune altered, not immunosuppressed, state.•Cytokines are protein mediators of immune function possessing pleiotropic and redundant functions.•The complex functions of immune cells are exquisitely orchestrated by cytokines.•Epidural technique-associated temperature elevation is mediated in part by cytokine disequilibrium.

Successful pregnancy requires a state of immune homeostasis. Maternal tolerance of the genetically distinct fetoplacental unit is in part mediated by maternal and fetal pro- and anti-inflammatory cytokines; these cytokines have also been implicated in different pregnancy-related pathologic states. This two-part series seeks to provide anesthesiologists with an overview on selected perinatal cytokines in an effort to identify opportunities for research and improvements in clinical care. In part one, we review basic and pregnancy-related elements of the immune system, with an emphasis on the role of cytokines. From this foundation, we offer a perspective of a unique phenomenon witnessed within obstetric anesthesia – maternal temperature elevation associated with labor epidural analgesia.