Pregnancy outcomes and community health: the POUCH study of preterm birth

Abstract

In light of the social/ethnic disparity in preterm delivery (PTD) rates, the Pregnancy Outcomes and Community Health (POUCH) Study takes a broad view of the determinants of PTD by attempting to link underlying biological and psychosocial factors. The relationships between placental pathology, maternal biomarkers, and antecedent psychosocial factors are evaluated in three hypothesised pathways of PTD – one characterised primarily by infection, one by maternal vascular disease, and one by premature elevations in corticotropin releasing hormone in the absence of histological evidence of placental pathology. Within each pathway, an emphasis is placed on understanding the roles of stress and of maternal serum alpha‐fetoprotein, an early biomarker associated with PTD. The POUCH Study enrols pregnant women from five Michigan communities. Information about these women and their environments is gathered through detailed interviews and collection of biological samples including hair, urine, saliva, blood, vaginal fluid, and vaginal smear at 15–26 weeks of gestation. We have chosen to focus on the second trimester – a time when pathological processes may have evolved to a detectable stage, but generally before the onset of biological changes that accompany labour. This focus is consistent with the long‐range goal of early detection/intervention and prevention of PTD.

Association Between Pre-Pregnancy Depression/Anxiety Symptoms and Hypertensive Disorders of Pregnancy

“…Additional details about the sampling scheme and the study sample are reported elsewhere. 27 To account for the stratified sampling, all analyses use sampling weights to arrive at unbiased estimates and standard errors that represent the original sampling frame. The present analysis is based upon the 1371 POUCH study subcohort women who completed a health history survey at enrollment and whose hypertensive disorder status was abstracted from medical records.…”

Placental Vascular Pathology Findings and Pathways to Preterm Delivery

“…The POUCH Study was a prospective cohort study designed to examine pathways to preterm delivery in 3,019 pregnant women (27). Between August 1998 and June 2004, pregnant women were recruited from 52 clinics in 5 Michigan communities.…”

“…The POUCH Study placental examination protocol has been described elsewhere (27). Briefly, placentas were formalin-fixed and grossly examined by the study placental pathologist.…”

Prepregnancy Depressive Mood and Preterm Birth in Black and White Women: Findings from the CARDIA Study

“…It has been suggested that adopting a cohort study design reduces the bias that can occur in samples drawn from clinics at teaching or referral hospitals. 77 Third, we assessed depressive mood prospectively, eliminating problems of recall bias.…”