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Am J Obstet Gynecol. 2012 Mar;206(3):236.e1-8. doi: 10.1016/j.ajog.2011.12.004. Epub 2011 Dec 16.

Fetal-placental inflammation, but not adrenal activation, is associated with extreme preterm delivery.

Author information

1
Division of Endocrinology, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.

Abstract

OBJECTIVE:

Spontaneous labor at term involves the activation of placental corticotropin-releasing hormone and the fetal adrenal axis, but the basis for extreme preterm labor is unknown. Our objective was to determine whether placental corticotropin-releasing hormone is activated in extreme preterm labor.

STUDY DESIGN:

One thousand five hundred six mothers delivering at less than 28 weeks' gestation were enrolled. Each mother/infant pair was assigned to the category that described the primary reason for hospitalization. Observers who had no knowledge of patient categorization assessed placenta microbiology, histology, and corticotropin-releasing hormone expression. These were correlated with the primary reason for hospitalization.

RESULTS:

Among infants delivered at less than 28 weeks' gestation, spontaneous (vs induced) delivery was associated with less placental corticotropin-releasing hormone expression and more frequent signs of placental inflammation and infection.

CONCLUSION:

Inflammation and infection, rather than premature activation of the fetal adrenal axis, should be the major focus of research to prevent extremely preterm human birth.

PMID:
22264652
PMCID:
PMC3696892
DOI:
10.1016/j.ajog.2011.12.004
[Indexed for MEDLINE]
Free PMC Article

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