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Histologic chorioamnionitis and preterm delivery.

Claudia Holzman1, Ximin Lin, Patricia Senagore

  • 1Department of Epidemiology, Michigan State University, East Lansing, MI, USA. holzman@msu.edu

American Journal of Epidemiology
|July 13, 2007
PubMed
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Histologic chorioamnionitis (HCA) definition and exclusion criteria significantly impact its association with preterm delivery. Specific HCA criteria reveal ethnic disparities, particularly in African Americans, contributing to preterm birth disparities.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Epidemiology
  • Pathology

Background:

  • Inconsistent findings link placental histologic chorioamnionitis (HCA) to preterm delivery.
  • Variations in HCA definition, population, and exclusion criteria may explain these inconsistencies.

Purpose of the Study:

  • To investigate how different HCA definitions and exclusion criteria affect the association with preterm delivery.
  • To examine the role of HCA in ethnic disparities in preterm birth.

Main Methods:

  • Analysis of 1,053 women from the Pregnancy Outcomes and Community Health Study (1998-2004).
  • Construction of multiple HCA definitions based on leukocyte thresholds, placental components, and inflammation staging.
  • Comparison of HCA-preterm delivery associations across different definitions and racial/ethnic groups.

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Main Results:

  • HCA is associated with preterm delivery before 35 weeks, especially in African Americans.
  • Effect size varied significantly with HCA definition, strengthening after excluding medically indicated preterm births.
  • Specific HCA criteria identified substantial differences in HCA prevalence between African Americans and Whites/others among preterm deliveries.

Conclusions:

  • HCA definition, exclusion criteria, and race/ethnicity critically influence the HCA-preterm delivery association.
  • HCA contributes to ethnic disparities observed in preterm birth rates.