Improving Health Outcomes and Equity by Targeting Postpartum Mothers at Highest Risk

针对风险最高的产后母亲，改善健康成果和公平

• 批准号: 10392562
• 负责人: Elizabeth A Howell
• 金额: $ 127.49万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-18 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10392562
• 关键词: Address; Anxiety; Asians; Attention; Attenuated; Behavioral; Birth; Blood Pressure; Body mass index; Buffers; COVID-19; COVID-19 mortality; COVID-19 pandemic; Cardiovascular system; Cessation of life; Childbirth; Color; Communities; Coronavirus; Dangerousness; Data; Discrimination; Economics; Educational Intervention; Emergency department visit; Enrollment; Evidence based intervention; Exposure to; Goals; Health; Healthcare; High Risk Woman; Home; Hospitals; Hypertension; Immigrant; Individual; Inequality; Infection; Intervention; Investigation; Latina; Latinx; Maternal Health; Maternal Mortality; Measures; Mental Depression; Mental Health; Methods; Morbidity - disease rate; Mothers; New York City; Outcome; Parents; Patient Self-Report; Patients; Personal Satisfaction; Persons; Philadelphia; Postpartum Depression; Postpartum Period; Psychiatric Diagnosis; Quality of life; Recording of previous events; Reporting; Research; Risk; SARS-CoV-2 infection; Stress; Structural Racism; Structure; Surveys; Testing; Time; Virus; Waist-Hip Ratio; Woman; Work; anxiety symptoms; base; black women; cardiovascular health; cohort; design; experience; health related quality of life; high risk; hospital readmission; improved; maternal morbidity; mortality; mortality disparity; multi-ethnic; pandemic disease; postpartum care; postpartum complications; postpartum health; pregnancy related death; prospective; racial and ethnic; racial and ethnic disparities; racism; recruit; resilience; segregation; severe maternal morbidity; social; social vulnerability; socioeconomics

Summary Racism is under scrutiny as a fundamental cause of racial-ethnic inequity in maternal morbidity and mortality, and now, the COVID-19 pandemic is replicating existing structures of inequality and disproportionately harming communities of color. Current evidence on racism in birthing people centers around birth outcomes, with little known of its influence on maternal postpartum health, when racial-ethnic disparities in maternal mortality are widest. Thus, it is urgent to investigate the influence of racism on postpartum maternal morbidity during the COVID-19 pandemic. To fill this gap, we propose a prospective postpartum cohort examining the influence of exposure to structural and interpersonal racism and the COVID-19 pandemic on postpartum maternal health. This goal aligns with that of the parent R01, to identify high-risk women in the postpartum period and design and implement a behavioral educational intervention to reduce inequity in maternal mortality and morbidity. We will recruit a postpartum cohort of 400 multiethnic mothers in Philadelphia and New York City. Our primary aim is to assess multiple levels of racism using contextual and self-reported measures at delivery, then prospectively follow postpartum patients three months to assess blood pressure (BP) trajectories, anxiety, depression, and quality of life among. Our second aim is to explore associations between COVID-19 exposures, including infection or social and economic stress, and postpartum maternal morbidity outcomes. Finally, we will test if individual or community resilience buffers associations between racism and postpartum maternal morbidity. The proposed study will provide new evidence of the influence of perceived and structural racism on postpartum maternal morbidity, with a focus on outcomes with strong ties to maternal mortality. Our findings will be used to target exposure to racism as a driver of maternal morbidity and resilience as a modifiable buffer in the design of a multilevel intervention to reduce maternal mortality.

概括 种族主义受到审查，这是孕产妇发病率和种族不平等的基本原因 死亡率，现在，Covid-19大流行正在复制现有的不平等结构， 不成比例地伤害有色人种。目前关于分娩的人集中种族主义的证据 当种族族裔差异 孕产妇死亡率最广泛。因此，迫切需要研究种族主义对产后母亲的影响 19009年大流行期间的发病率。为了填补这一空白，我们提出了一个预期的产后队列 研究暴露于结构和人际种族主义的影响以及COVID-19对 产后孕产妇健康。这个目标与父母R01的目标保持一致，以识别高危女性 产后时期并设计并实施行为教育干预措施，以减少不平等 孕产妇的死亡率和发病率。我们将招募费城400个多民族母亲的产后队列 和纽约市。我们的主要目的是使用上下文和自我报告评估多个种族主义 分娩时的措施，然后前瞻性跟踪产后患者三个月以评估血压 （BP）轨迹，焦虑，抑郁和生活质量。我们的第二个目标是探索关联 在包括感染或社会和经济压力在内的共同曝光与产后孕产妇之间 发病率结果。最后，我们将测试个人或社区弹性缓冲之间的关联 种族主义和产后孕产妇发病率。拟议的研究将提供新的证据证明 对产后孕产妇发病率的感知和结构性种族主义，重点是与 孕产妇死亡率。我们的发现将用于针对种族主义作为母体发病率和 在设计多层次干预措施时，弹性作为一种可修改的缓冲液，以降低孕产妇死亡。