Epidemiology of Abruptio Placentae in Peru

摘要胎盘早剥是指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(坎宁安，)。虽然以前的研究结果表明，AP的病因尚不清楚 建议一些风险因素，其中几个可能是可以修改的。简而言之，结果来自几个小的 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， 证实并扩展了这些早期的发现。也有一些证据表明 产妇感染/炎症状态与AP风险增加之间的关系。我们寻求通过以下方式在这一工作的基础上再接再厉 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 孕妇和胎盘样本(用于检测生物标志物)和多因素Logistic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 作为我们评估目标的一部分，我们将评估大约400名AP患者和400名对照的血清同型半胱氨酸。 低叶酸和其他B族维生素的代谢结果与AP风险的关系。此外，我们还将评估 关于母亲感染/炎症状态的假设[通过C-反应蛋白(CRP)和PRO来衡量] 炎性细胞因子，如肿瘤坏死因子-a(TNF-a)和可溶性肿瘤坏死因子受体(STNFpSS)，以及 临床和/或组织学绒毛膜羊膜炎]是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风险与其他假定的风险因素之间的关联。需要考虑的风险因素包括年轻人和老年人 产妇年龄、多胎、母亲吸烟、死产史、剖腹产及其他 不良妊娠结局。 我们提议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对 确定最需要具体预防干预和专门临床护理的妇女亚群。 建议的研究结果可能对开发替代的、实用的预防措施具有实际意义。 AP和其他不良妊娠结局的干预措施(例如，先兆子痫和早产)。叶酸和其他 维他命B可以很容易地在饮食中通过补充剂使用或在有证据的情况下通过特定的食物选择来操纵 来自这项研究和其他研究表明是有益的。

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.