Socio-economic disparities in preterm birth: Causal pathways and mechanisms
| Autor: | Clément Dassa, Gideon Koren, Alice Benjamin, Louise Miner, Henriette Gauthier, John E. Lydon, Guylaine Asselin, Helen McNamara, Michael S. Kramer, Rima Rozen, André Masse, Lise Goulet, Michael Libman, Susan R. Kahn, Louise Séguin, Robert W. Platt, Jacques Genest, Moy Fong Chen, Julia Klein |
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| Předmět: |
Adult
medicine.medical_specialty Canada Epidemiology Placenta Chorioamnionitis Obstetric Labor Premature Pregnancy Stress Physiological medicine Humans Prospective Studies Prospective cohort study Prenatal vitamins Methylenetetrahydrofolate Reductase (NADPH2) Gynecology Vaginal Smears Oxidoreductases Acting on CH-NH Group Donors Fetal fibronectin biology business.industry Obstetrics Case-control study Social Support medicine.disease Socioeconomic Factors Methylenetetrahydrofolate reductase Case-Control Studies Pediatrics Perinatology and Child Health biology.protein Cervix Mucus Female Bacterial vaginosis business Biomarkers Blood Chemical Analysis Hair |
| Zdroj: | Scopus-Elsevier |
| Popis: | Preterm birth is the leading cause of infant mortality in industrialised societies. Its incidence is greatly increased among the socially disadvantaged, but the reasons for this excess are unclear and have been relatively unexplored. We hypothesise two distinct sets of causal pathways and mechanisms that may explain social disparities in preterm birth. The first set involves chronic and acute psychosocial stressors, psychological distress caused by those stressors, increased secretion of placental corticotropin releasing hormone (CRH), changes in sexual behaviours or enhanced susceptibility to bacterial vaginosis and chorioamnionitis, cigarette smoking or cocaine use, and decidual vasculopathy. The second hypothesised pathway is a gene-environment interaction based on a highly prevalent mutation in the gene for methylenetetrahydrofolate reductase (MTHFR), combined with low folate intake from the diet and from prenatal vitamin supplements, consequent hyperhomocysteinemia, and decidual vasculopathy. We propose to test these hypothesised pathways and mechanisms in a nested case-control study within a prospectively recruited and followed cohort of pregnant women with singleton pregnancies who deliver at one of four Montreal hospitals that serve an ethnically and socio-economically diverse population. Following recruitment during the late first or early second trimester, participating women are seen at 24-26 weeks, when a research nurse obtains a detailed medical and obstetric history; administers several scales to assess chronic and acute stressors and psychological function; obtains blood samples for CRH, red blood cell and plasma folate, homocysteine, and DNA for the MTHFR mutation; and performs a digital and speculum examination to measure cervical length and vaginal pH and to obtain swabs for bacterial vaginosis and fetal fibronectin. After delivery, each case (delivery at < 37 completed weeks following spontaneous onset of labour or prelabour rupture of membranes) and two controls are selected for placental pathological examination, hair analysis of cotinine, cocaine, and benzoylecgonine, and analysis of stored blood and vaginal specimens. Statistical analysis will be based on multiple logistic regression and structural equation modelling, with sequential construction of models of potential aetiological determinants and covariates to test the hypothesised causal pathways and mechanisms. The research we propose should improve understanding of the factors and processes that mediate social disparities in preterm birth. This improved understanding should help not only in developing strategies to reduce the disparities but also in suggesting preventive interventions applicable across the entire socio-economic spectrum. |
| Databáze: | OpenAIRE |
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