Epidemiology of Abruptio Placentae in Peru

描述(申请人提供)：胎盘早剥(AP)，正常植入胎盘的过早分离，是妊娠的一种危及生命的产科并发症(Cunningham，1989)。AP的病因尚不清楚，尽管以前的研究结果表明有一些危险因素，其中几个可能是可以修改的。简而言之，几项小型研究的结果表明，母亲叶酸和其他B族维生素的摄入量较低可能与AP风险增加有关。一篇关于有急性胰腺炎病史的女性血液中同型半胱氨酸浓度的新文献证实并扩展了这些早期的发现。也有一些证据表明，母体感染/炎症状态与AP风险增加之间存在关联。我们寻求在这项工作的基础上，在秘鲁利马进行一项关于AP的病例对照研究。我们将使用病例对照设计，包括收集母体和胎盘样本(用于测试生物标志物)和多变量Logistic回归分析，以评估AP风险与低叶酸、维生素B6和维生素B的生物标志物之间的关系。我们将评估大约400名AP患者和400名对照的母体血清同型囊氨酸，作为我们评估低叶酸和其他B族维生素与AP风险的代谢结果的一部分。此外，我们将评估母体感染/炎症状态[通过C-反应蛋白(CRP)和促炎细胞因子如肿瘤坏死因子(TNF-a)和可溶性肿瘤坏死因子受体(STNFp55)，以及临床和/或组织学绒毛膜羊膜炎]作为AP的危险因素的假设。 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。要考虑的危险因素包括产妇年龄早、高龄、多胎、母亲吸烟、有死产史、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经历AP的高危孕妇的能力，并进一步了解AP发生的机制。我们建议的研究结果有很高的潜力产生病因学和临床信息，这些信息可能被证明是识别最需要特定预防干预和专门临床护理的妇女亚群的有效方法。拟议研究的结果可能对开发针对AP和其他不良妊娠结局(例如先兆子痫和早产)的替代、实用的预防性干预措施具有实际意义。叶酸和其他B族维生素可以很容易地在饮食中通过补充使用或通过特定的食物选择来操纵，如果这项研究和其他研究的证据表明有益的话。

DESCRIPTION (provided by applicant): 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-a (sTNFp55), 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 include young 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.