Pregnancy outcomes and community health: the POUCH study of preterm delivery

In light of the social/ethnic disparity in preterm delivery (PTD) rates, th e Pregnancy Outcomes and Community Health (POUCH) Study takes a broad view of the determinants of PTD by attempting to link underlying biological and psychosocial factors. The relationships between placental pathology, matern al biomarkers, and antecedent psychosocial factors are evaluated in three h ypothesised pathways of PTD-one characterised primarily by infection, one b y maternal vascular disease, and one by premature elevations in corticotrop in releasing hormone in the absence of histological evidence of placental p athology. Within each pathway, an emphasis is placed on understanding the r oles of stress and of maternal serum alpha-fetoprotein, an early biomarker associated with PTD. The POUCH Study enrols pregnant women from five Michig an communities. Information about these women and their environments is gat hered through detailed interviews and collection of biological samples incl uding hair, urine, saliva, blood, vaginal fluid, and vaginal smear at 15-26 weeks of gestation. We have chosen to focus on the second trimester-a time when pathological processes may have evolved to a detectable stage, but ge nerally before the onset of biological changes that accompany labour. This focus is consistent with the long-range goal of early detection/interventio n and prevention of PTD.