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American Journal of Epidemiology Advance Access originally published online on June 9, 2009
American Journal of Epidemiology 2009 170(2):159-161; doi:10.1093/aje/kwp128
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Invited Commentary

Invited Commentary: Intrauterine Epidemiology

Thomas F. McElrath and Jonathan L. Hecht

Correspondence to Dr. Thomas F. McElrath, Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 (e-mail: tmcelrath{at}partners.org).

Received for publication March 13, 2009. Accepted for publication March 31, 2009.

Traditionally, the investigation of preterm birth has relied on diagnostic definitions derived from maternal clinical presentation. However, clinical presentation may be only tangentially related to the underlying etiology of a disease. The utilization of data derived directly from the intrauterine or maternal systemic environment would be invaluable in consideration of the causes of preterm birth. In this issue, Kelly et al. (Am J Epidemiol. 2009;170(2)148–158) contribute to our understanding of the epidemiology of the intrauterine environment by classifying the vascular biology of the maternal-placental interface in cases of preterm delivery. Their histology-based approach observes that vascular conditions may be grouped into 5 constructs with specific relations to maternal and fetal vascular pathology. The frequencies of these constructs vary with regard to delivery indication and gestational age, suggesting that the intrauterine conditions associated with preterm birth are more complicated than originally appreciated. This work is laborious, and replication of the technique will be important. However, these authors have taken a large step toward introducing an "intrauterine" perspective into perinatal epidemiology and into our understanding of the underlying etiologies of preterm birth.

blood vessels; placenta; premature birth


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Related articles in Am. J. Epidemiol.:

Placental Vascular Pathology Findings and Pathways to Preterm Delivery
R. Kelly, C. Holzman, P. Senagore, J. Wang, Y. Tian, M. H. Rahbar, and H. Chung
Am. J. Epidemiol. 2009 170: 148-158. [Abstract] [Full Text]  



This article has been cited by other articles:


Home page
 Am J EpidemiolHome page
C. Holzman, P. Senagore, and R. Kelly
Holzman et al. Respond to "Intrauterine Epidemiology"
Am. J. Epidemiol., July 15, 2009; 170(2): 162 - 163.
[Full Text] [PDF]


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