Psychological, cultural and neuroendocrine profiles of risk for preterm birth.
BACKGROUND
Preterm birth remains a major obstetrical problem and identification of risk factors for preterm birth continues to be a priority in providing adequate care. Therefore, the purpose of this study was to elucidate risk profiles for preterm birth using psychological, cultural and neuroendocrine measures.


METHODS
From a cross sectional study of 515 Mexican American pregnant women at 22-24 weeks gestation, a latent profile analysis of risk for preterm birth using structural equation modeling (SEM) was conducted. We determined accurate gestational age at delivery from the prenatal record and early ultrasounds. We also obtained demographic and prenatal data off of the chart, particularly for infections, obstetrical history, and medications. We measured depression (Beck Depression Inventory), mastery (Mastery scale), coping (The Brief Cope), and acculturation (Multidimensional Acculturation Scale) with reliable and valid instruments. We obtained maternal whole blood and separated it into plasma for radioimmunoassay of Corticotrophin Releasing Hormone (CRH). Delivery data was obtained from hospital medical records.


RESULTS
Using a latent profile analysis, three psychological risk profiles were identified. The "low risk" profile had a 7.7% preterm birth rate. The "moderate risk" profile had a 12% preterm birth rate. The "highest risk" profile had a 15.85% preterm birth rate. The highest risk profile had double the percentage of total infections compared to the low risk profile. High CRH levels were present in the moderate and highest risk profiles.


CONCLUSIONS
These risk profiles may provide a basis for screening for Mexican American women to predict risk of preterm birth, particularly after they are further validated in a prospective cohort study. Future research might include use of such an identified risk profile with targeted interventions tailored to the Hispanic culture.
Texas A&M University Health Science Center College of Nursing, 8447 State Highway 47, Bryan, TX, 77807-3260, USA. Roberta.ruiz@tamhsc.edu.
R Jeanne
RJ
Ruiz
Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, A3302 Biostatistical and Epidemiological Consulting Lab, 4801 Alberta Avenue, El Paso, TX, 79905, USA. Alok.dwivedi@ttuhsc.edu.
Alok Kumar
AK
Dwivedi
Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, A3302 Biostatistical and Epidemiological Consulting Lab, 4801 Alberta Avenue, El Paso, TX, 79905, USA. Indika.mallawaarachichi@ttuhsc.edu.
Indika
I
Mallawaarachichi
The University of Texas School of Public Health, El Paso Regional Campus, 1100 North Stanton Suite 110, El Paso, TX, 79902, USA. hector.g.balcazar@uth.tmc.edu.
Hector G
HG
Balcazar
Microgen Laboratories, 903 Texas Avenue, La Marque, TX, 77568, USA. rpstowe@microgenlabs.com.
Raymond P
RP
Stowe
Texas A&M University Health Science Center College of Nursing, 3950 N A.W. Grimes Blvd, Round Rock, TX, 78665, USA. ayers@tamhsc.edu.
Kimberly S
KS
Ayers
The Ohio State University College of Nursing, Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA. Pickler.1@osu.edu.
Rita
R
Pickler
D000069:Acculturation; D000328:Adult; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000208:ethnology*; D004964:Estriol / Q000097:blood*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D017058:Mexican Americans / Q000706:statistics & numerical data; D011247:Pregnancy; D047928:Premature Birth / Q000097:blood / Q000453:epidemiology* / Q000523:psychology*; D011446:Prospective Studies; D018570:Risk Assessment; D013315:Stress, Psychological / Q000097:blood / Q000453:epidemiology / Q000208:ethnology; D016216:Ultrasonography, Prenatal; D014481:United States; D055815:Young Adult
D004964:Estriol