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premature delivery. Women with pPROM are at increased risk of developing chorioamnionitis,
an infection of the fetal membranes and placenta.Chorioamnionitis-exposed premature infants
are at increased risk of perinatal brain injury, when compared to infants born prematurely for
other reasons. It is not clear why some women with pPROM develop infection whereas other
women with pPROM do not.

Psychological stress has been associated with low birth weight and preterm delivery. Although
psychological stress has definable effects on neuroendocrine and immunological functioning
during pregnancy and otherwise, its effect on women with pPROM has not been evaluated
previously. In the proposed study, we will prospectively test the hypothesis that psychological
stress is associated with the development of chorioamnionitis among women with pPROM,
and that the mechanism linking stress to intrauterine infection involves activation of the TH1
type cytokines in face of elevated cortisol concentrations.
.
We will test our hypothesis by 1) determining if psychological stress is associated with
earlier delivery and a higher incidence of chorioamnionitis among women with pPROM, 2)
determining if psychological stress is associated with alterations in immune markers and
with elevated salivary cortisol concentrations, and 3) determining if psychological stress
among women with pPROM is associated with a higher incidence of neonatal neurologic
injury .Psychological stress is measured by a combination of psychological batteries,
physiologic assessments (heart rate, blood pressure, and heart rate variability) and
neuroendocrine mechanisms (salivary cortisol levels).Gestational age at delivery is
determined from a combination of best obstetric estimate (last menstrual period and first
trimester ultrasound) or the Revised Neonatal Ballard Score, if obstetric dating not available.
Chorioamnionitis is diagnosed by placental histology. Forty women and children >14 years
of age who are at 24 0/7-32 0/7 weeks gestation carrying a single fetus and who are admitted
to Magee-Womens Hospital with the diagnosis of pPROM will be enrolled in the study.

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  3/23/2006  la/tc

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