Preterm premature rupture of the fetal membranes (PPROM) is one of the most significant causes of preterm birth. PPROM is complicated by infection of the placenta and membranes (chorioamnionitis) in about half the cases, increasing the likelihood of adverse infant outcomes. Because stress has been associated with both preterm birth and altered immune function, we hypothesized that stress would increase the risk of chorioamnionitis among women with PPROM who were not actively infected upon presentation. Stress was measured by both physiological [salivary cortisol and serum Corticotropin Releasing Hormone (CRH) levels] and psychological (stress questionnaires: the Psychiatric Epidemiology Research Questionnaire, the Daily Hassles Scale, the 14-item Perceived Stress Scale, and the Interpersonal Support Evaluation List) means. Logistic regression was used to determine the association between stress and the development of chorioamnionitis and between stress and a composite adverse neonatal outcome (death or abnormal cranial ultrasound finding). Linear regression was used to assess the association between stress and latency (time from rupture of membranes until delivery). A one SD increase in mean salivary cortisol concentration was associated with a 3-fold increased odds of developing chorioamnionitis (OR 3.17, 95% CI 0.88-11.46), and an 8.6 fold increased odds of adverse neonatal outcomes (OR 8.62, 95% CI 0.99-75.03). A 1 SD increase in CRH was associated with a 33% increased odds of chorioamnionitis (OR 1.33, 95% CI 0.50-3.53) and a 3.5 fold increased odds of adverse neonatal outcomes (OR 3.45, 95% CI 0.55-21.56). Stress batteries were not associated with the development of either chorioamnionitis or adverse neonatal outcomes. There was little relationship between either physiologic or psychological measures of stress and latency. Physiologic measures of stress in women with PPROM may be associated with an increased risk of adverse obstetric and neonatal outcomes, specifically the development of chorioamnionitis and the composite newborn outcome of death or abnormal cranial ultrasound findings. Since prematurity is the most important causes of death and disability among children in developed countries, our finding is of significant public health importance. If a role for stress in the etiology of PPROM-associated chorioamnionitis is confirmed, then stress-reduction techniques may reduce adverse neonatal outcomes
