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American Journal of Epidemiology Advance Access originally published online on September 9, 2009
American Journal of Epidemiology 2009 170(8):1014-1024; doi:10.1093/aje/kwp218
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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.

ORIGINAL CONTRIBUTIONS

Maternal Catecholamine Levels in Midpregnancy and Risk of Preterm Delivery

Claudia Holzman, Patricia Senagore, Yan Tian, Bertha Bullen, Eric DeVos, Cheryl Leece, Adroaldo Zanella, Gregory Fink, Mohammad H. Rahbar and Anjali Sapkal

Correspondence to Dr. Claudia Holzman, Department of Epidemiology, Michigan State University, B601 West Fee Hall, East Lansing, MI 48824 (e-mail: holzman{at}msu.edu).

Received for publication February 12, 2009. Accepted for publication June 23, 2009.

Associations between stress hormones and preterm delivery have not been fully explored. In this study, pregnant women enrolled from 52 clinics in 5 Michigan communities (1998–2004) provided urine samples for 3 days (waking and bedtime) during midpregnancy. Urinary catecholamine levels (epinephrine, norepinephrine, and dopamine) were measured in a subcohort (247 preterm and 760 term deliveries), and a 3-day median value was calculated. Polytomous logistic regression models assessed relations between catecholamine quartiles (of the median) and a 4-level outcome variable (i.e., term (referent) and 3 preterm delivery subtypes: spontaneous; premature rupture of membranes; and medically indicated). Final models incorporated other relevant covariates (e.g., creatinine, demographic, behavior). The risk of spontaneous preterm delivery was increased in the highest versus lowest quartile of norepinephrine and dopamine: norepinephrine, waking (adjusted odds ratio (AOR) = 3.7, 95% confidence interval (CI): 1.8, 7.9) and bedtime (AOR = 2.5, 95% CI: 1.3, 4.9); dopamine, waking (AOR = 2.6, 95% CI: 1.4, 5.1) and bedtime (AOR = 2.3, 95% CI: 1.2, 4.6). Adjusted odds ratios were further strengthened after removing women whose placentas showed evidence of acute infection or vascular pathology. High catecholamine levels in maternal urine may be indicative of excess stressors and/or predisposition to elevated sympathetic activation that contributes to increased risk of spontaneous preterm delivery.

catecholamines; dopamine; epinephrine; gestational age; norepinephrine; pregnancy; pregnancy outcome; premature birth

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; MSAFP, maternal serum {alpha}-fetoprotein; POUCH, Pregnancy Outcomes and Community Health


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