Maternal Catecholamine Levels in Midpregnancy and Risk of Preterm Delivery

• Published in: American journal of epidemiology 2009-10, Vol.170 (8), p.1014-1024
• Main Authors: Holzman, Claudia, Senagore, Patricia, Tian, Yan, Bullen, Bertha, DeVos, Eric, Leece, Cheryl, Zanella, Adroaldo, Fink, Gregory, Rahbar, Mohammad H., Sapkal, Anjali
• Format: Article
• Language: English
• Subjects: Analysis. Health state; Biological and medical sciences; catecholamines; Catecholamines - urine; Childbirth & labor; Creatinine - blood; Diseases of mother, fetus and pregnancy; dopamine; Epidemiology; epinephrine; Female; Fetal Membranes, Premature Rupture - urine; General aspects; gestational age; Gynecology. Andrology. Obstetrics; Hormones; Humans; Maternal & child health; Medical sciences; Middle Aged; norepinephrine; Original Contributions; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy. Fetus. Placenta; premature birth; Premature Birth - urine; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Young Adult
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/aje/kwp218

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.