Socio‐economic disparities in preterm birth
Causal pathways and mechanisms
Bibliographic Data
Preterm birth is the leading cause of infant mortality in industrialised societies. Its incidence is greatly increased among the socially disadvantaged, but the reasons for this excess are unclear and have been relatively unexplored. We hypothesise two distinct sets of causal pathways and mechanisms that may explain social disparities in preterm birth. The first set involves chronic and acute psychosocial stressors, psychological distress caused by those stressors, increased secretion of placental corticotropin releasing hormone (CRH), changes in sexual behaviours or enhanced susceptibility to bacterial vaginosis and chorioamnionitis, cigarette smoking or cocaine use, and decidual vasculopathy. The second hypothesised pathway is a gene–environment interaction based on a highly prevalent mutation in the gene for methylenetetrahydrofolate reductase (MTHFR), combined with low folate intake from the diet and from prenatal vitamin supplements, consequent hyperhomocysteinemia, and decidual vasculopathy. We propose to test these hypothesised pathways and mechanisms in a nested case‐control study within a prospectively recruited and followed cohort of pregnant women with singleton pregnancies who deliver at one of four Montreal hospitals that serve an ethnically and socio‐economically diverse population. Following recruitment during the late first or early second trimester, participating women are seen at 24–26 weeks, when a research nurse obtains a detailed medical and obstetric history; administers several scales to assess chronic and acute stressors and psychological function; obtains blood samples for CRH, red blood cell and plasma folate, homocysteine, and DNA for the MTHFR mutation; and performs a digital and speculum examination to measure cervical length and vaginal pH and to obtain swabs for bacterial vaginosis and fetal fibronectin. After delivery, each case (delivery at The research we propose should improve understanding of the factors and processes that mediate social disparities in preterm birth. This improved understanding should help not only in developing strategies to reduce the disparities but also in suggesting preventive interventions applicable across the entire
Allele · Bacterial vaginosis · Environmental health · Fetal fibronectin · Fetus · Methylenetetrahydrofolate reductase · Obstetrics · Population · Pregnancy · Psychiatry · Psychosocial · Stressor · Genetics · Maternal and Perinatal Health Interventions · Maternal Mental Health During Pregnancy and Postpartum · Medicine · Preterm Birth and Chorioamnionitis
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| Unique citing works | 58 |
|---|---|
| Citations per year | 2,42 |
| Citation span | 2002 - 2023 (22) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 54 |