A Signature of Maternal Anti-Fetal Rejection in Spontaneous Preterm Birth: Chronic Chorioamnionitis, Anti-Human Leukocyte Antigen Antibodies, and C4d

Chronic chorioamnionitis is found in more than one-third of spontaneous preterm births. Chronic chorioamnionitis and villitis of unknown etiology represent maternal anti-fetal cellular rejection. Antibody-mediated rejection is another type of transplantation rejection. We investigated whether there was evidence for antibody-mediated rejection against the fetus in spontaneous preterm birth.This cross-sectional study included women with (1) normal pregnancy and term delivery (n = 140) and (2) spontaneous preterm delivery (n = 140). We analyzed maternal and fetal sera for panel-reactive anti-HLA class I and class II antibodies, and determined C4d deposition on umbilical vein endothelium by immunohistochemistry. Maternal anti-HLA class I seropositivity in spontaneous preterm births was higher than in normal term births (48.6% vs. 32.1%, p = 0.005). Chronic chorioamnionitis was associated with a higher maternal anti-HLA class I seropositivity (p<0.01), significant in preterm and term birth. Villitis of unknown etiology was associated with increased maternal and fetal anti-HLA class I and II seropositivity (p<0.05, for each). Fetal anti-HLA seropositivity was closely related to maternal anti-HLA seropositivity in both groups (p<0.01, for each). C4d deposition on umbilical vein endothelium was more frequent in preterm labor than term labor (77.1% vs. 11.4%, p<0.001). Logistic regression analysis revealed that chronic chorioamnionitis (OR = 6.10, 95% CI 1.29–28.83), maternal anti-HLA class I seropositivity (OR = 5.90, 95% CI 1.60–21.83), and C4d deposition on umbilical vein endothelium (OR = 36.19, 95% CI 11.42–114.66) were associated with preterm labor and delivery.A major subset of spontaneous preterm births has a signature of maternal anti-fetal cellular and antibody-mediated rejections with links to fetal graft-versus-host disease and alloimmune reactions

Leadership for Literacy Coaching: The Principal’s Role in Launching a New Coaching Program

Purpose: This study investigated the relationship between principal leadership and variation in teachers' participation in a new literacy coaching program: Content-Focused Coaching® (CFC). Research design: Twenty-nine schools were randomly assigned to participate in the CFC program or to serve as a comparison. Interviews were conducted with elementary school principals and coaches, and teachers completed surveys describing their experiences with their new coach. Correlation analyses investigated the relationship between the categories of principal support and the frequency of teachers' participation in individual coaching activities. Principals' actions and beliefs were also compared across schools, with teachers' relatively high and low participation in coaching, to identify patterns in principal leadership. Findings: Principal leadership was significantly associated with the frequency with which teachers conferred with their new CFC coach and were observed by their new coach as teaching reading comprehension lessons. Principal behaviors associated with teachers' increased engagement with coaches included actively participating in the CFC program and publicly endorsing the coach as a source of literacy expertise to teachers. Principal beliefs regarding a literacy coach's role and responsibilities were associated with the frequency with which teachers opened their classrooms to the new coaches. Implications: This study provides insight into the features of principal leadership that may support coaches in engaging with teachers and gaining access to their classrooms. Observing teachers' lessons is a critical dimension of effective coaching and a difficult task for coaches to accomplish. Learning how principals can positively contribute to this process could help schools and districts make more effective use of their literacy coaching resources. © The University Council for Educational Administration 2009