A protocol to identify non-classical risk factors for preterm births: the Brazilian Ribeirão Preto and São Luís prenatal cohort (BRISA)

Reproductive Health

Heloísa Bettiol²  Rosângela Fernandes Lucena Batista¹  Ricardo Carvalho Cavalli²  Rejane Christine de Sousa Queiroz¹  Erika Bárbara Abreu Fonseca Thomaz¹  Claudia Maria Coelho Alves¹  Viviane Cunha Cardoso²  Marco Antonio Barbieri²  Vanda Maria Ferreira Simões¹  Antônio Augusto Moura da Silva¹ 

[1] Departamento de Saúde Pública, Universidade Federal do Maranhão (UFMA). Rua Barão de Itapary, 155 Centro, 65020-070 São Luís, Maranhão, Brasil;Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil

关键词: Infection;    Stress, psychological;    Risk factors;    Premature birth;    Prenatal care;    Cohort studies;   

Others  :  1132096
DOI  :  10.1186/1742-4755-11-79

 received in 2014-10-07, accepted in 2014-11-07,  发布年份 2014

【 摘 要 】

Background

Preterm birth is the main cause of morbidity and mortality during the perinatal period. Classical risk factors are held responsible for only 1/3 of preterm births and no current intervention has produced an appreciable reduction of this event. It is necessary to explore new hypotheses and mechanisms of causality by using an integrated approach, collaboration among research groups and less fragmented theoretical-methodological approaches in order to detect new risk factors and to formulate more effective intervention strategies.

Methods

The study will be conducted on a convenience cohort of Brazilian pregnant women recruited at public and private prenatal health services. A total of 1500 pregnant women in São Luís, and 1500 in Ribeirão Preto, will be invited for an interview and for the collection of biological specimens from the 22nd to the 25th week of gestational age (GA). At the time of delivery they will be reinterviewed. GA will be determined using an algorithm based on two criteria: date of last menstruation (DLM) and obstetric ultrasound (OUS) performed at less than 20 weeks of GA. Illicit drug consumption during pregnancy will be determined using a self-applied questionnaire and the following instruments will be used: perceived stress scale, Beck anxiety scale, screening for depression of the Center of Epidemiological Studies (CES-D), experiences of racial discrimination, social network and social support scale of the Medical Outcomes Study and violence (Abuse Assessment Screening and violence questionnaire of the WHO). Bacterial vaginosis, urinary tract infection and periodontal disease will also be identified. Neuroendocrine, immunoinflammatory and medical intervention hypotheses will be tested. The occurrence of elective cesarean section in the absence of labor will be used as a marker of medical intervention.

Conclusion

Psychosocial, genetic and infectious mechanisms will be selected, since there are indications that they influence preterm birth (PTB). The studies will be conducted in two Brazilian cities with discrepant socioeconomic conditions. The expectation is to identify risk factors for PTB having a greater predictive power than classically studied factors. The final objective is to propose more effective interventions for the reduction of PTB, which, after being tested, might subsidize health policies.

【 授权许可】

   
2014 da Silva et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, Adler A, Vera Garcia C, Rohde S, Say L, Lawn JE: National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012, 379:2162-2172.
• [2]Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S, Lackritz EM, Lee SK, Mason E, Serazin AC, Walani S, Simpson JL, Lawn JE, Born Too Soon preterm prevention analysis group: Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 2013, 381:223-234.
• [3]Bettiol H, Barbieri MA, Silva AA: Epidemiology of preterm birth: current trends. Rev Bras Ginecol Obstet 2010, 32:57-60.
• [4]Kramer MS, Platt R, Yang H, Joseph KS, Wen SW, Morin L, Usher RH: Secular trends in preterm birth: a hospital-based cohort study. Jama 1998, 280:1849-1854.
• [5]Joseph KS, Demissie K, Kramer MS: Obstetric intervention, stillbirth, and preterm birth. Semin Perinatol 2002, 26:250-259.
• [6]Bettiol H, Rona RJ, Chinn S, Goldani M, Barbieri MA: Factors associated with preterm births in southeast Brazil: a comparison of two birth cohorts born 15 years apart. Paediatr Perinat Epidemiol 2000, 14:30-38.
• [7]Barros FC, Victora CG, Barros AJ, Santos IS, Albernaz E, Matijasevich A, Domingos MR, Sclowitz IK, Hallal PC, Silveira MF, Vaughan JP: The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004. Lancet 2005, 365:847-854.
• [8]Gravett MG, Rubens CE, Nunes TM, APPS Review Group: Global report on preterm birth and stillbirth (2 of 7): discovery science. BMC Pregnancy Childbirth 2010, 10(Suppl 1):S2. BioMed Central Full Text
• [9]Kramer MS, Seguin L, Lydon J, Goulet L: Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatr Perinat Epidemiol 2000, 14:194-210.
• [10]Zhang YP, Liu XH, Gao SH, Wang JM, Gu YS, Zhang JY, Zhou X, Li QX: Risk factors for preterm birth in five Maternal and Child Health hospitals in Beijing. PLoS One 2012, 7:e52780.
• [11]Wadhwa PD, Culhane JF, Rauh V, Barve SS, Hogan V, Sandman CA, Hobel CJ, Chicz-DeMet A, Dunkel-Schetter C, Garite TJ, Glynn L: Stress, infection and preterm birth: a biobehavioural perspective. Paediatr Perinat Epidemiol 2001, 15(Suppl 2):17-29.
• [12]Warren SL, Racu C, Gregg V, Simmens SJ: Maternal panic disorder: Infant prematurity and low birth weight. J Anxiety Disord 2006, 20:342-352.
• [13]Witt WP, Cheng ER, Wisk LE, Litzelman K, Chatterjee D, Mandell K, Wakeel F: Preterm birth in the United States: the impact of stressful life events prior to conception and maternal age. Am J Public Health 2014, 104(Suppl 1):S73-S80.
• [14]Ruiz RJ, Fullerton J, Dudley DJ: The interrelationship of maternal stress, endocrine factors and inflammation on gestational length. Obstet Gynecol Surv 2003, 58:415-428.
• [15]Rich-Edwards J, Krieger N, Majzoub J, Zierler S, Lieberman E, Gillman M: Maternal experiences of racism and violence as predictors of preterm birth: rationale and study design. Paediatr Perinat Epidemiol 2001, 15(Suppl 2):124-135.
• [16]Mustillo S, Krieger N, Gunderson EP, Sidney S, Mccreath H, Kiefe CI: Self- reported experiences of racial discrimination and Black-White differences in preterm and low-birthweight deliveries: the CARDIA Study. Am J Public Health 2004, 94:2125-2131.
• [17]Anthopolos R, Kaufman JS, Messer LC, Miranda ML: Racial residential segregation and preterm birth: built environment as a mediator. Epidemiology 2014, 25:397-405.
• [18]Giscombe CL, Lobel M: Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull 2005, 131:662-683.
• [19]Ahmed S, Koenig MA, Stephenson R: Effects of domestic violence on perinatal and early- childhood mortality: evidence from north India. Am J Public Health 2006, 96:1423-1428.
• [20]Nongrum R, Thomas E, Lionel J, Jacob KS: Domestic violence as a risk factor for maternal depression and neonatal outcomes: a hospital-based cohort study. Indian J Psychol Med 2014, 36:179-181.
• [21]Pizzo G, La Cara M, Conti Nibali M, Guiglia R: Periodontitis and preterm delivery. A review of the literature. Minerva Stomatol 2005, 54:1-14.
• [22]Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S: Periodontal disease and adverse pregnancy outcomes: a systematic review. Bjog 2006, 113:135-143.
• [23]Pretorius C, Jagatt A, Lamont RF: The relationship between periodontal disease, bacterial vaginosis, and preterm birth. J Perinat Med 2007, 35:93-99.
• [24]Macones GA, Parry S, Elkousy M, Clothier B, Ural SH, Strauss JF: A polymorphism in the promoter region of TNF and bacterial vaginosis: preliminary evidence of gene-environment interaction in the etiology of spontaneous preterm birth. Am J Obstet Gynecol 2004, 190:1504-1508.
• [25]Moore S, Ide M, Randhawa M, Walker JJ, Reid JG, Simpson NA: An investigation into the association among preterm birth, cytokine gene polymorphisms and periodontal disease. Bjog 2004, 111:125-132.
• [26]Edmonds JK, Yehezkel R, Liao X, Moore Simas TA: Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study. BMC Pregnancy Childbirth 2013, 3:168.
• [27]Hamilton BE, Hoyert DL, Martin JA, Strobino DM, Guyer B: Annual summary of vital statistics: 2010–2011. Pediatrics 2013, 131:548-558.
• [28]Feldman PJ, Dunkel-Schetter C, Sandman CA, Wadhwa PD: Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosom Med 2000, 62:715-725.
• [29]Griep RH, Chor D, Faerstein E, Werneck GL, Lopes CS: Construct validity of the medical outcomes Study's social support scale adapted to Portuguese in the Pro-saude study. Cad Saude Publica 2005, 21:703-714.
• [30]Nkansah-Amankra S, Dhawain A, Hussey JR, Luchok KJ: Maternal social support and neighborhood income inequality as predictors of low birth weight and preterm birth outcome disparities: analysis of South Carolina Pregnancy Risk Assessment and Monitoring System survey, 2000–2003. Matern Child Health J 2010, 14:774-785.
• [31]Kramer MS, Goulet L, Lydon J, Seguin L, Mcnamara H, Dassa C, Platt RW, Chen MF, Gauthier H, Genest J, Kahn S, Libman M, Rozen R, Masse A, Miner L, Asselin G, Benjamin A, Klein J, Koren G: Socio- economic disparities in preterm birth: causal pathways and mechanisms. Paediatr Perinat Epidemiol 2001, 15(Suppl 2):104-123.
• [32]Baerwald CG, Panayi GS, Lanchbury JS: A new XmnI polymorphism in the regulatory region of the corticotropin releasing hormone gene. Hum Genet 1996, 97:697-698.
• [33]Foxman B, Wen A, Srinivasan U, Goldberg D, Marrs CF, Owen J, Wing DA, Misra D: Mycoplasma, bacterial vaginosis-associated bacteria BVAB3, race, and risk of preterm birth in a high-risk cohort. Am J Obstet Gynecol 2014, 210:226.e1-7.
• [34]Huck O, Tenenbaum H, Davideau JL: Relationship between periodontal diseases and preterm birth: recent epidemiological and biological data. J Pregnancy 2011, 2011:1-8.
• [35]Romero R, Oyarzun E, Mazor M, Sirtori M, Hobbins JC, Bracken M: Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstet Gynecol 1989, 73:576-582.
• [36]Silva AA, Barbieri MA, Bettiol H, Goldani MZ, Rona RJ: Can we explain why Brazilian babies are becoming lighter? Int J Epidemiol 2004, 33:821-828.
• [37]PNUD Brasil: Ranking do HDI dos municípios do Brasil em 2010. [http://www.pnud.org.br/atlas/ranking/Ranking-IDHM-Municipios-2010.aspx webcite]
• [38]IBGE - Instituto Brasileiro De Geografia e Estatística [http://censo2010.ibge.gov.br webcite]
• [39]Barbieri MA, Bettiol H, Silva AA, Cardoso VC, Simões VM, Gutierrez MR, Castro JA, Vianna ES, Foss MC, Dos Santos JE, Queiroz RG: Health in early adulthood: the contribution of the 1978/79 Ribeirão Preto birth cohort. Braz J Med Biol Res 2006, 39:1041-1055.
• [40]Silva AA, Coimbra LC, Da Silva RA, Alves MT, Lamy Filho F, Carvalho Lamy Z, Gomide Mochel E, Aragão VM, Ribeiro VS, Tonial SR, Barbieri MA: Perinatal health and mother-child health care in the municipality of São Luis, Maranhão State, Brazil. Cad Saude Publica 2001, 17:1413-1423.
• [41]Verburg BO, Steegers EAP, De Ridder M, Snijders RJM, Smith E, Hofman A, Moll HA, Jaddoe VWV, Witteman JCM: New charts for ultrasound dating of pregnancy and assessment of fetal growth: longitudinal data from a population-based cohort study. Ultrasound Obstet Gynecol 2008, 31:388-396.
• [42]Centers For Disease Control And Prevention & American College Of Obstetricians And Gynecologists Atlanta: Intimate partner violence during pregnancy: a guide for clinicians; [http://www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence/ipvdp_thumbnails.htm webcite]
• [43]Krieger N: Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med 1990, 30:1273-1281.
• [44]Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM: Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med 2005, 61:1576-1596.
• [45]Faerstein E, Chor D, Lopes CS, Werneck GL: Estudo Pró-Saúde: observações adicionais sobre temas e métodos. Rev Bras Epidemiol 2005, 8:474-476.
• [46]Chor D, Griep RH, Lopes CS, Faerstein E: Social network and social support measures from the Pro-Saude Study: pre-tests and pilot study. Cad Saude Publica 2001, 17:887-896.
• [47]World Health Organization: Oral Health Surveys Basic Methods. 4th edition. Geneva: World Health Organization; 1997.
• [48]Silness J, Loe H: Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964, 22:121-135.
• [49]Loe H, Silness J: Periodontal disease in pregnancy. i. prevalence and severity. Acta Odontol Scand 1963, 21:533-551.
• [50]Bjorby A, Loe H: The relative significance different local factors in the initiation and development of periodontal inflammation. J Periodontal Res 1967, 2:76-77.
• [51]Novak MJ, Johns LP, Miller RC, Bradshaw MH: Adjunctive benefits of subantimicrobial dose doxycycline in the management of severe, generalized, chronic periodontitis. J Periodontol 2002, 73:762-769.
• [52]Mittal V, Bhullar RPK, Bansal R, Singh K, Bhalodi A, Khinda PK: A practicable approach for periodontal classification. Dent Res J 2013, 10:697-703.
• [53]Wiebe CB, Putnins EE: The periodontal disease classification system of the American Academy of Periodontology–an update. J Can Dent Assoc 2000, 66:594-597.
• [54]Highield J: Diagnosis and classification of periodontal disease. Aust Dent J 2009, 54(1 Suppl):S11-S26.
• [55]Page RC, Eke PI: Case definitions for use in population-based surveillance of periodontitis. J Periodontol 2007, 78(7 Suppl):1387-1399.
• [56]Iranzo-Cortés JE, Montiel-Company JM, Almerich-Silla JM: Caries diagnosis: agreement between WHO and ICDAS II criteria in epidemiological surveys. Community Dent Health 2013, 30:108-111.
• [57]Benzian H, Monse B, Heinrich-Weltzien R, Hobdell M, Mulder J, van Palenstein Helderman W: Untreated severe dental decay: a neglected determinant of low Body Mass Index in 12-year-old Filipino children. BMC Public Health 2011, 13:558.
• [58]McNair RD, MacDonald SR, Dooley SL, Peterson LR: Evaluation of the centrifuged and Gram-stained smear, urinalysis, and reagent strip testing to detect asymptomatic bacteriuria in obstetric patients. Am J Obstet Gynecol 2000, 182:1076-1079.
• [59]Nugent RP, Krohn MA, Hillier SL: Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991, 29:297-301.
• [60]Honest H, Bachmann LM, Knox EM, Gupta JK, Kleijnen J, Khan KS: The accuracy of various tests for bacterial vaginosis in predicting preterm birth: a systematic review. Bjog 2004, 111:409-422.
• [61]Klebanoff MA, Hillier SL, Nugent RP, MacPherson CA, Hauth JC, Carey JC, Harper M, Wapner RJ, Trout W, Moawad A, Leveno KJ, Miodovnik M, Sibai BM, Vandorsten JP, Dombrowski MP, O'Sullivan MJ, Varner M, Langer O, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network: Is bacterial vaginosis a stronger risk factor for preterm birth when it is diagnosed earlier in gestation? Am J Obstet Gynecol 2005, 192:470-477.
• [62]Sambrook J, Fritsch EF, Maniatis T: Molecular Cloning: A Laboratory Manual. New York: ColdSpring Harbor Laboratory Press; 1989.
• [63]Karplus TM, Jeronimo SM, Chang H, Helms BK, Burns TL, Murray JC, Mitchell AA, Pugh EW, Braz RF, Bezerra FL, Wilson ME: Association between the tumor necrosis factor locus and the clinical outcome of Leishmania chagasi infection. Infection and Immunit 2002, 70:6919-6925.
• [64]Rosmond R, Chagnon M, Bouchard C, Bjorntorp P: A polymorphism in the regulatory region of the corticotropin-releasing hormone gene in relation to cortisol secretion, obesity, and gene-gene interaction. Metabolism 2001, 50:1059-1062.
• [65]Kline RB: Principles and Practice of Structural Equation Modeling. New York: Guilford; 2011.
• [66]World Health Organization: March of Dimes, The Partnership for Maternal Newborn and Child Health, Save the Children, World Health Organization: Born too soon: the global action report on preterm birth. Geneva: World Health Organization; 2012.
• [67]Johnston RB Jr, Williams MA, Hogue CJ, Mattison DR: Overview: new perspectives on the stubborn challenge of preterm birth. Paediatr Perinat Epidemiol 2001, 15(Suppl 2):3-6.
• [68]Iams JD, Romero R, Culhane JF, Goldenberg RL: Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet 2008, 371:164-175.
• [69]Barros FC, Bhutta ZA, Batra M, Hansen TN, Victora CG, Rubens CE, GAPPS Review Group: Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions. BMC Pregnancy Childbirth 2010, 10(Suppl 1):S3. BioMed Central Full Text
• [70]Simmons LE, Rubens CE, Darmstadt GL, Gravett MG: Preventing preterm birth and neonatal mortality: exploring the epidemiology, causes, and interventions. Semin Perinatol 2010, 34:408-415.