Social stressors and inflammation: A mixed methods approach to preterm birth

社会压力源和炎症：早产的混合方法

• 批准号: 10200235
• 负责人: Carmen Giurgescu
• 金额: $ 26.65万
• 依托单位: UNIVERSITY OF CENTRAL FLORIDA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-06 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200235
• 关键词: Address; Adolescent; Age; Area; Biological; Birth; Blood; C-reactive protein; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Childhood; Chronic stress; Crime; Data; Discipline of obstetrics; Discrimination; Disease; Eclampsia; Ensure; Environment; Event; Exposure to; Goals; Hemorrhage; High Risk Woman; Individual; Infection; Infectious Pregnancy Complications; Inflammation; Inflammatory; Interleukin-4; Interleukin-6; Interleukin-8; Length; Leukocytes; Life Cycle Stages; Link; Live Birth; Maternal Mortality; Measures; Mediating; Medicaid; Medical History; Medical Records; Methods; Neighborhoods; Participant; Postpartum Hemorrhage; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Birth; Protein Analysis; Questionnaires; Reporting; Research; Risk; Role; Saliva; Serum; Time; Trauma; Woman; antepartum depression; cohort; cytokine; depressive symptoms; driving force; experience; high risk; indexing; maternal condition; maternal morbidity; maternal risk; men; perinatal health; pregnancy disorder; pregnancy related death; pregnant; prenatal; psychologic; racism; response; social stressor; socioeconomics; telomere

PROJECT SUMMARY/ABSTRACT Black women have the highest rates of maternal morbidity and mortality in the US. Maternal mortality is 3-4 times higher among Black women than White women (42 vs 13/ 100,000 live births). While deaths during pregnancy and the postpartum period can be linked to direct causes, such as cardiovascular events, infections, and hemorrhage, we must investigate factors further upstream if we are to reduce maternal mortality. Using a life course framework for perinatal health, we propose to study Black women’s lifetime trauma as an antecedent to the increased risks of maternal morbidity that underly maternal mortality. Lifetime trauma due to exposures to racism, living in neighborhoods with higher levels of disorder (e.g., vacant houses) and crime, and socioeconomic adversities throughout their lives may increase risk for maternal morbidity for Black women including pregnancy-related complications (e.g., preeclampsia), infections, cardiovascular disease and depressive symptoms. Shorter telomere length (TL), a biological measure of chronic stress, relates to racism, neighborhood disorder, and socioeconomic adversities; and increases the risk for depressive symptoms and cardiovascular. Lifetime trauma has also been related to greater systemic inflammation [e.g., higher levels of pro-inflammatory cytokines and C-Reactive Protein (CRP)] among Blacks. Our hypothesis is that lifetime trauma (measured by women’s reports and shorter TL) relates to higher risk for maternal morbidity; systemic inflammation mediates this association. The goal of this supplemental study is to examine the association of lifetime trauma with maternal morbidity among Black women, and whether alterations in systemic inflammation mediate this association. Our cohort is comprised of 658 pregnant Black women from the Detroit, MI and Columbus, OH areas. Women completed questionnaires about their experiences during childhood (age 10 as reference) and during pregnancy including racism, neighborhood disorder and crime, and socioeconomic adversity. Depressive symptoms during pregnancy were also measured. Women had blood drawn for cytokines and CRP analysis and saliva collected for TL. Obstetrical and medical history were abstracted from maternal medical records. For this supplemental study, we will use a global measure of maternal morbidity (e.g., preeclampsia, infections, cardiovascular conditions, depressive symptoms). We will link Medicaid claims data with our medical records abstraction data to ensure a comprehensive account of maternal morbidity for women during their pregnancy and within 1 year after birth. We aim to: (1) Examine the association of maternal morbidity with lifetime trauma (1a, women’s reports of lifetime trauma; 1b, TL); and (2) Examine the associations of systemic inflammation with lifetime trauma and maternal morbidity. This study will provide preliminary data for a larger study to examine the role of lifetime trauma on maternal morbidity among Black women.

项目概要/摘要 在美国，黑人妇女的孕产妇发病率和死亡率最高，为 3-4。 黑人女性的死亡率比白人女性高出一倍（42 比 13/100,000 活产婴儿）。 怀孕和产后期可能与直接原因有关，例如心血管事件、感染、 如果我们要降低孕产妇死亡率，我们必须进一步调查上游因素。 围产期健康的生命历程框架，我们建议研究黑人妇女的一生创伤作为 在孕产妇发病风险增加之前，导致孕产妇死亡的原因是终生创伤。 遭受种族主义、生活在混乱程度较高（例如空置房屋）和犯罪率较高的社区， 一生中的社会经济逆境可能会增加黑人妇女孕产妇发病的风险 包括与妊娠相关的并发症（例如先兆子痫）、感染、心血管疾病和 较短的端粒长度（TL）是慢性压力的生物学指标，与种族主义有关。 邻里混乱和社会经济逆境；并增加抑郁症状和 终生创伤也与更大的全身炎症有关[例如，更高水平的炎症反应。 促炎细胞因子和 C 反应蛋白 (CRP)] 在黑人中的寿命。 创伤（通过女性报告和较短的 TL 来衡量）与孕产妇全身发病风险较高有关； 炎症介导这种关联。 这项补充研究的目的是检查一生创伤与母亲的关系 黑人女性的发病率，以及全身炎症的改变是否介导了这种关联。 该队列由来自密歇根州底特律和俄亥俄州哥伦布地区的 658 名怀孕黑人妇女组成。 完成了有关他们童年时期（10 岁作为参考）和 怀孕，包括种族主义、邻里骚乱和犯罪以及社会经济逆境。 还测量了妇女怀孕期间的症状，进行细胞因子和 CRP 分析。 产科和病史收集的唾液是从母亲的病历中提取的。 在这项补充研究中，我们将使用全球孕产妇发病率衡量标准（例如先兆子痫、感染、 我们会将医疗补助索赔数据与我们的医疗记录联系起来。 提取数据以确保全面了解妇女怀孕期间的孕产妇发病率 我们的目标是在出生后 1 年内：(1) 检查孕产妇发病率与终生创伤的关系。 （1a，女性一生创伤的报告；1b，TL）；（2）检查全身炎症的关联 这项研究将为更大规模的研究提供初步数据。 研究终生创伤对黑人妇女孕产妇发病率的影响。