Placental Blood Flow and the Risk of Preterm Delivery

Misra, Vinod K.; Hobel, Calvin J.; Sing, Charles F.

doi:10.1016/j.placenta.2009.04.007

Cited by 59 publications

(50 citation statements)

References 35 publications

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“…49 Importantly in the context of pregnancy, placental blood flow has been implicated in risk for preterm delivery, as has maternal endothelial dysfunction. [50][51][52] Thus, although not testable in the current investigation, vascular effects present a potential mechanistic link by which sleep induced elevations in IL-8 may affect birth timing.…”

Section: Discussionmentioning

confidence: 78%

Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans

Blair

Porter

Leblebicioğlu

et al. 2015

Sleep

161

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1259Sleep and Preterm Birth-Blair et al. INTRODUCTIONIn the United States, preterm birth affects 11.5% of deliveries and is the underlying cause of more than one third of infant deaths.1 A high proportion of surviving preterm infants suffer from severe physical and cognitive consequences, potentially requiring intensive medical and/or educational support throughout the lifespan.2 The morbidity and mortality associated with preterm birth pose significant drains on the financial and emotional resources of afflicted families, and on the nation as a whole, costing more than $26 billion annually in the United States. 3Inflammation is a causal mechanism in the initiation of preterm as well as term labor. 4 Inflammatory mediators can initiate contractions, encourage cervical ripening, and cause rupture of the membranes.4,5 Via these mechanisms, inflammation induced by infection or psychological stress may trigger early parturition. 6,7Importantly, poor sleep promotes inflammation.8 For example, in a population-based cohort of more than 5,000 adults, shorter sleep duration was associated with elevations in Study Objectives: Poor sleep promotes inflammation. In turn, inflammation is a causal mechanism in term as well as preterm parturition. In the United States, a persistent racial disparity in preterm birth exists, with African Americans showing ~1.5 times greater risk. This study examined associations among sleep quality, serum proinflammatory cytokines, and length of gestation in a racially diverse sample of 138 pregnant women. Design: Observational. Measurements: Women completed the Pittsburgh Sleep Quality Index (PSQI) and other psychosocial and behavioral measures during midpregnancy. Serum levels of interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α were determined by high-sensitivity assays. Birth outcomes were determined via medical record review. Results: Among African American women (n = 79), shorter gestation was predicted by poorer overall sleep (r s = −0.35, P = 0.002) as well the following PSQI subscales: subjective sleep quality (r s = −0.34, P = 0.002), sleep latency (r s = −0.27, P = 0.02), and sleep efficiency (r s = −0.27, P = 0.02). African American women with poor sleep quality (PSQI > 5) had 10.2 times the odds of preterm birth compared to those with good sleep quality. In contrast, among European American women (n = 53), gestational length was not significantly predicted by sleep quality (Ps > 0.12). Bootstrapping analyses showed that, among African Americans, IL-8 significantly mediated the association between sleep quality and length of gestation (indirect effect estimate −0.029; 95% confidence interval −0.06, −0.002). Conclusions:The data provide novel evidence that African American women exhibit greater inflammation in response to sleep disturbance than European American women and these effects correspond with length of gestation. Racial differences in susceptibility to sleep induced immune dysregulation may contribute to marked racial disparities in preterm birth.

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Section: Discussionmentioning

confidence: 78%

Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans

Blair

Porter

Leblebicioğlu

et al. 2015

Sleep

161

View full text Add to dashboard Cite

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“…Our strict preterm definition, together with our evaluation for distal villous hypoplasia, and the strength of our tightly controlled multicenter trial, reinforces prior studies from the 1990s [20,27], suggesting that placental insufficiency may cause idiopathic PTB. Moreover, emphasizing the potential significance of the role of placental insufficiency in idiopathic PTB is timely provided differences in blood flow [23,24], novel genetic signatures [5] and serum proteomics [6]. …”

Section: Discussionmentioning

confidence: 99%

“…Placental insufficiency is a clinical term [8] essentially used to describe our ignorance [9], but placental findings appear to be related to oxidative stress [10–12]. The underlying cause may be abnormal uterine spiral artery remodeling [13–22], leading to abnormal uteroplacental blood flow [10,23,24]. …”

Section: Introductionmentioning

confidence: 99%

Placental villous hypermaturation is associated with idiopathic preterm birth

Morgan¹,

Tolosa²,

Mele³

et al. 2012

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective Pregnancy complications such as intra-amniotic infection, preeclampsia, and fetal intrauterine growth restriction (IUGR) account for most cases of preterm birth (PTB), but many spontaneous PTB cases do not have a clear etiology. We hypothesize that placental insufficiency may be a potential cause of idiopathic PTB. Methods Secondary analysis of 82 placental samples from women with PTB obtained from a multicenter trial of repeat versus single antenatal corticosteroids. Samples were centrally reviewed by a single placental pathologist masked to clinical outcomes. The histopathologic criterion for infection was the presence of acute chorioamnionitis defined as neutrophils marginating into the chorionic plate. Placental villous hypermaturation (PVH) was defined as a predominance of terminal villi (similar to term placenta) with extensive syncytial knotting. Idiopathic PTB comprised a group without another known etiology such as preeclampsia, IUGR or infection. Results Acute chorioamnionitis was observed in 33/82 (40%) cases. Other known causes of PTB were reported in 18/82 (22%). The remaining 31/82 (38%) were idiopathic. The frequency of PVH in idiopathic PTB (26/31=84%) was similar to cases with IUGR or preeclampsia (16/ 18=89%), but significantly more common than PVH in the group with acute chorioamnionitis (10/33=30%) (p<0.001). Conclusions PVH, which is a histologic marker of relative placental insufficiency, is a common finding in idiopathic PTB.

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“…S/D, PI, and RI are indicators of vascular resistance and perfusion rates. In some cases, placental or umbilical vessel dysfunction can induce adverse pregnancy outcomes, such as pre-eclampsia, gestational diabetes, IUGR and so on [30][31][32].…”

Section: Discussionmentioning

confidence: 99%