Vasculopathic and thrombophilic risk factors for spontaneous preterm birth

Authors: Kramer, Michael S¹; Kahn, Susan R²; Rozen, Rima¹; Evans, Rhobert²; Platt, Robert W¹; Chen, Moy Fong²; Goulet, Lise²; Séguin, Louise²; Dassa, Clément²; Lydon, John²; McNamara, Helen²; Dahhou, Mourad³; Genest, Jacques²

Source: International Journal of Epidemiology, Volume 38, Number 3, 4 June 2009 , pp. 715-723(9)

Publisher: Oxford University Press

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Abstract:

Background Mothers who give birth to preterm infants are at increased risk of mortality from coronary heart disease and stroke, but the biological pathways underlying these associations have not been explored.

Methods We carried out a case-control study nested in a large (n = 5337) prospective, multicentre cohort. All cohort women had an interview, examination and venipuncture at 24-26 weeks. Frozen plasma samples in spontaneous preterm births (n = 207) and 444 term controls were analysed for plasma homocysteine, folate, cholesterol (total, low-density lipoprotein and high-density lipoprotein) and thrombin-antithrombin (TAT) complexes. DNA was extracted and analysed for seven gene polymorphisms involved in thrombophilia or folate or homocysteine metabolism. Fresh placentas were fixed, stained and blindly assessed for histologic evidence of infarction and decidual vasculopathy.

Results High (above the median) plasma homocysteine and HDL cholesterol were significantly and independently associated with the risk of spontaneous preterm birth [adjusted odds ratios (OR)s = 1.9 (95% 1.1-3.3) and 0.5 (0.3-0.9), respectively]. A higher proportion of women with high homocysteine concentrations had decidual vasculopathy [(13.0 vs 6.8%; OR = 1.9 (1.1-3.5)], although the positive association between decidual vasculopathy and preterm birth did not achieve statistical significance [OR = 1.5 (0.9-2.7)]. No significant associations were observed with the DNA polymorphisms or with plasma TAT or folate levels.

Conclusions Similar vasculopathic risk factors may underlie preterm birth and adult coronary heart disease and stroke.

Keywords: Preterm birth; coronary heart disease; stroke; biological pathways

Document Type: Research article

DOI: http://dx.doi.org/10.1093/ije/dyp167

Affiliations: 1: Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada., , 2: , 3: Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada.,

Publication date: 2009-06-04

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The International Journal of Epidemiology is an essential requirement for anyone who needs to keep up to date with epidemiological advances and new developments throughout the world. It encourages communication among those engaged in the research, teaching, and application of epidemiology of both communicable and non-communicable disease, including research into health services and medical care.

Vasculopathic and thrombophilic risk factors for spontaneous preterm birth

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