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American Journal of Epidemiology Advance Access originally published online on July 11, 2007
American Journal of Epidemiology 2007 166(7):786-794; doi:10.1093/aje/kwm168
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Histologic Chorioamnionitis and Preterm Delivery

Claudia Holzman1, Ximin Lin1, Patricia Senagore2 and Hwan Chung1

1 Department of Epidemiology, Michigan State University, East Lansing, MI
2 Department of Physiology, Michigan State University, East Lansing, MI

Correspondence to Dr. Claudia B. Holzman, B601 West Fee Hall, East Lansing, MI 48824 (e-mail: holzman{at}msu.edu).

Received for publication October 24, 2006. Accepted for publication March 21, 2007.

Inconsistent findings linking placental histologic chorioamnionitis (HCA) and preterm delivery may result from variations in HCA definition, population studied, and exclusion criteria. This analysis from the 1998–2004 Pregnancy Outcomes and Community Health Study (five Michigan communities) includes the first 1,053 subcohort women (239 preterm, 814 term) with completed placental assessments. Multiple HCA definitions were constructed by 1) varying polymorphonuclear leukocytes/high-powered field thresholds and placenta components included and 2) using polymorphonuclear leukocyte characteristics to assign low/high maternal, fetal inflammation stage and grade. In African Americans, HCA was associated with preterm delivery before 35 weeks. The effect size was modest for polymorphonuclear leukocytes/high-powered field thresholds of greater than 10 and greater than 30 (odds ratios (ORs) = 0.8 and 2.0); larger for greater than 100 (OR = 3.2, 95% confidence interval (CI): 1.4, 7.1); strengthened after excluding medically indicated preterm deliveries (OR = 4.9, 95% CI: 2.0, 11.8); and strongest for high maternal/high fetal HCA (OR = 5.6, 95% CI: 1.4, 22.1). These latter HCA criteria also produced the largest effect size in Whites/others (OR = 2.7, 95% CI: 0.3, 26.9). Among preterm deliveries before 35 weeks excluding those medically indicated, 12% of Whites/others and 55% of African Americans had high maternal HCA. The authors conclude that HCA definition, exclusion criteria, and race/ethnicity influence the HCA-preterm delivery association and that HCA contributes to preterm delivery-related ethnic disparity.

chorioamnionitis; continental population groups; infection; inflammation; neutrophils; placenta; premature birth; term birth

Abbreviations: CI, confidence interval; HCA, histologic chorioamnionitis; OR, odds ratio


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