Mechanisms for Preterm Birth in African-American Women

描述(申请人提供)：在全国范围内，每年有11%的孕妇经历自然早产，但只有40%-50%的早产结束于早产。早产的机制仍然知之甚少，特别是在非裔美国妇女中，特别是在早产(怀孕34周之前)。在我们早期由联邦政府资助的研究中，与足月儿的母亲相比，早产儿的母亲在分娩时、产后1个月、2个月和4个月时的免疫功能明显较差(对刀豆蛋白A、商陆有丝分裂原和植物血凝素反应的淋巴细胞增殖减少)。然而，目前尚不清楚这种改变的免疫反应是否在早产之前就存在。感染也被认为是早产的原因之一，我们的一个研究团队最近的工作将宫颈阴道细胞因子的增加与非妊娠妇女的阴道感染联系起来，强调了检查局部和全身细胞免疫反应与分娩结果之间关系的必要性。这项研究将比较三组非裔美国女性的压力(压力感知，CRH)、感染(衣原体、淋病、细菌性阴道病)、健康行为(吸烟、营养)和免疫反应(宫颈阴道和血清IL-1、IL-6和TNF-α)：20名经历正常妊娠和足月分娩的非洲裔美国妇女，20名早产在24-34周之间的早产妇女，20名在34周前分娩的早产妇女。这项研究将为我们提供必要的初步数据，以支持重大拨款申请，使我们能够标准化实验室程序，并通过提供血清、宫颈和阴道细胞因子水平之间的相关性数据，为更大规模的研究提供方法学信息。它还将提供初步数据，以确定哪些因素最能区分经历过早产但足月分娩的非裔美国女性，以及经历过早产并早产的非裔美国女性，以及从不早产且足月分娩的非裔美国女性。

DESCRIPTION (provided by applicant): Nationally, 11% of pregnant women experience a spontaneous preterm delivery every year but only 40-50% of preterm labors end in preterm delivery. The mechanism for preterm delivery remains poorly understood especially among African-American women and especially in early preterm labor (prior to 34 weeks gestation). In our earlier federally funded work, mothers of preterm infants compared to mothers of term infants had significantly poorer immune function (diminished lymphocyteproliferation in response to concanavalin A, pokeweed mitogen, and phytohemagglutinin) at delivery, and 1, 2 and 4 months postpartum. However, it is not known if this altered immune response was present prior to preterm delivery. Infection is also purported to be a causative factor in preterm birth and recent work by one of our research team linking increases in cervicovaginal cytokines with vaginal infections in non pregnant women underscores the need to examine the relationship between local and systemic cellular immune response to birth outcomes. This study will compare stress (perception of stress, CRH), infection (chlamydia, gonorrhea, bacterial vaginosis), health behaviors (smoking, nutrition) and immune response (cervicovaginal and serum IL-1, IL-6 and TNF-alpha) between three groups of African-American women: 20 experiencing a normal pregnancy and term delivery, 20 women presenting between 24-34 weeks of gestation in preterm labor delivering at term and 20 women presenting between 24-34 weeks of gestation in preterm labor who deliver before 34 weeks gestation. The study will provide us with necessary preliminary data to support a major grant submission, allow us to standardize laboratory procedures and inform the methodology of the larger study by providing data on the correlation between serum, cervical, and vaginal cytokine levels. It will also provide preliminary data to identify those factors that best differentiate African American women who experience preterm labor but deliver at term from those who deliver experience preterm labor and deliver prematurely from those who never labor prematurely and who deliver at term.