Epidemiology of Abruptio Placentae in Peru

秘鲁胎盘早剥的流行病学

• 批准号: 7344827
• 负责人: MICHELLE A. WILLIAMS
• 金额: $ 3.03万
• 依托单位: SWEDISH MEDICAL CENTER, FIRST HILL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-02-01 至 2010-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7344827
• 关键词: Abruptio Placentae; Address; American; Antioxidants; Behavioral; Biological Markers; Blood; C-reactive protein; Caring; Case-Control Studies; Cessation of life; Characteristics; Chronic; Clinical; Constitutional; Copper; Data; Developed Countries; Developing Countries; Diet; Dietary intake; Diffuse; Discipline of obstetrics; Disease; Epidemiology; Epoprostenol; Equilibrium; Etiology; Fatty Acids; Folate; Food; Functional disorder; Goals; High Risk Woman; Hospitals; Hyperlipidemia; Hypertriglyceridemia; Implant; Infection; Infection of amniotic sac and membranes; Inflammation; Inflammatory; Institution; Intake; Interleukin-6; Intervention; Iron; Iron deficiency anemia; Knowledge; Laboratory Technicians; Lead; Life; Literature; Logistics; Marines; Maternal Mortality; Measures; Metabolic; Micronutrients; Modification; Morbidity - disease rate; Multiparity; Nutritional status; Outcome; Parents; Pathologist; Perinatal; Peru; Placenta; Play; Population Study; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnant Women; Premature Birth; Preventive Intervention; Principal Investigator; Prostaglandins I; Protein C; Recommendation; Recording of previous events; Regression Analysis; Research; Research Personnel; Riboflavin; Risk; Risk Factors; Risk Marker; Role; Sampling; Selenium; Serum; Societies; South American; Subgroup; TNFR-Fc fusion protein; Testing; Thromboxanes; Trace metal; Tumor Necrosis Factor Receptor; Tumor Necrosis Factor-alpha; Tumor Necrosis Factors; Vascular Diseases; Vitamin B 12; Vitamin B Complex; Vitamin B6; Woman; Work; Zinc; advanced maternal age; analytical method; base; case control; cohort; cytokine; design; experience; human MPP1 protein; human TNF protein; implantation; maternal cigarette smoking; maternal serum; mortality; normotensive; parent grant; parity; racial and ethnic; receptor; stillbirth; transcriptional coactivator p75; vascular endothelial dysfunction

Abruptio placentae (AP), the premature separation of the normally implanted placenta, is a life threatening obstetric complication of pregnancy (Cunningham, 1989). The etiology of AP is unknown though results from previous studies suggest some risk factors, several of which may be amenable to modification. Briefly, results from several small studies suggest that low maternal intake of folate and other B vitamins may be associated with an increased risk of AP. An emerging literature concerning homocyst(e)ine concentrations in the blood of women with a history of AP, corroborates and expands upon those earlier findings. There is also some evidence suggestive of an association between maternal infection/inflammatory status and increased risk of AP. We seek to build on this body of work by conducting a case-control study of AP in Lima, Peru. We will use a case-control design that includes, collecting maternal and placental samples (used for testing biological markers) and multivariate logistic regression analysis to assess the relation between risk of AP and biological markers of low folate, vitamin B6, and vitamin B)2. Maternal serum homocyst(e)ine will be assessed in approximately 400 AP cases and 400 controls as part of our aim of evaluating the metabolic consequence of low folate and other B vitamins in relation to risk of AP. Additionally, we will assess hypotheses concerning maternal infection/inflammatory status [as measured by C-reactive protein (CRP) and the pro- inflammatory cytokines such as tumor necrosis factor-a (TNF-a) and the soluble receptor for TNF-oc (sTNFpSS), and clinical and/or histological chorioamnionitis] as risk factors of AP. In addition to addressing the primary hypotheses, data collected for the proposed study will allow for a reevaluation of the association between AP risk and other putative risk factors. Risk factors to be considered includeyoung and advanced maternal age, grand multiparity(parity > 5), maternal smoking, prior history of stillbirth, c-section delivery and other adverse pregnancy outcomes. The ultimate goals of our proposed research are to increase the ability to identify pregnant women at high risk of experiencing AP, and to further understand the mechanisms by which AP occurs. Results from our proposed research have a very high potential for yielding etiologic and clinical information that may prove to be effective in the identification of subgroups of women at greatest need for specific preventive interventions and specialized clinical care. Results from the proposed study could have practical significance in developing alternative, practical preventative interventions for AP and other adverse pregnancy outcomes (e.g., preeclampsia and preterm delivery). Folate and other B vitamins could be easily manipulated in the diet either by supplement use or by specific choice of foods if evidence from this and other studies indicates a benefit.

胎盘早剥（AP），即正常植入的胎盘过早分离，是一种危及生命的产科疾病， 妊娠并发症（Cunningham，1989）。虽然从先前的研究结果来看，AP的病因尚不清楚 提示了一些风险因素，其中一些可能是可以修改的。简单地说，结果从几个小的 研究表明，母亲叶酸和其他B族维生素摄入量低可能与AP风险增加有关。 一项关于有AP病史的女性血液中同型半胱氨酸浓度的新兴文献， 它证实并扩展了这些早期的发现。也有一些证据表明 母亲感染/炎症状态与AP风险增加之间的关系。我们力求在这一工作基础上再接再厉， 在秘鲁利马进行AP病例对照研究。我们将使用病例对照设计，包括，收集 母体和胎盘样品（用于测试生物标志物）和多变量逻辑回归分析， 评估AP风险与低叶酸、维生素B6和维生素B生物标志物之间的关系。产妇 作为我们评估AP患者血清同型半胱氨酸水平的目的之一，我们将对大约400例AP患者和400例对照者进行评估。 低叶酸和其他B族维生素与AP风险相关的代谢后果。此外，我们将评估 关于母体感染/炎症状态的假设[通过C-反应蛋白（CRP）和促炎症反应蛋白（CRP）测定] 炎性细胞因子，如肿瘤坏死因子-α（TNF-α）和TNF-α的可溶性受体（sTNF β SS），和 临床和/或组织学绒毛膜炎]作为AP的危险因素。 除了解决主要假设外，为拟议研究收集的数据将允许重新评估 AP风险与其他假定风险因素之间的关联。要考虑的风险因素包括年轻和先进 产妇年龄、多胎次（胎次> 5）、产妇吸烟、死产史、剖腹产和其他 不良妊娠结局。 我们提出的研究的最终目标是提高识别高危孕妇的能力。 体验AP，并进一步了解AP发生的机制。我们提议的研究结果 有很高的潜力产生病原学和临床信息，可能被证明是有效的， 确定最需要具体预防干预和专门临床护理的妇女亚组。 从拟议的研究结果可能有实际意义，在开发替代，实用的预防 AP和其他不良妊娠结局的干预措施（例如，先兆子痫和早产）。叶酸及其他 B族维生素可以很容易地在饮食中操纵，无论是通过补充使用或通过特定的食物选择，如果证据 这项研究和其他研究表明，这是有益的。