Improving maternal and child health through prenatal fatty acid supplementation: A randomized controlled study in African American women living in low-income urban environments

通过产前补充脂肪酸改善孕产妇和儿童健康：一项针对生活在低收入城市环境中的非裔美国妇女的随机对照研究

• 批准号: 9135142
• 负责人: Kathryn Elizabeth Keenan
• 金额: $ 59.39万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-04 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9135142
• 关键词: Adverse event; Affect; African American; Age-Months; Anxiety; Apgar Score; Behavior assessment; Behavioral; Biological; Birth; Birth Weight; Blood; Blood Pressure; C-reactive protein; Cell membrane; Chicago; Child; Chronic stress; Clinical Services; Data; Development; Diet; Dietary Intervention; Discipline of obstetrics; Docosahexaenoic Acids; Emotional; Emotions; Environment; Erythrocytes; Essential Fatty Acids; Event; Exposure to; Face; Family; Fatty Acids; Fetus; Fishes; Foundations; Funding; Gestational Age; Goals; Health; Heart Rate; Hormones; Hydrocortisone; Immunologic Markers; Impairment; Infant; Infant Development; Infant Health; Insurance; Intake; Interleukin-6; Laboratories; Learning; Life; Link; Low Birth Weight Infant; Low income; Maternal Health; Maternal and Child Health; Measures; Mediating; Mediation; Medicaid; Medical Records; Mental Depression; Methodology; Modeling; Mothers; National Institute of Child Health and Human Development; National Institute of Mental Health; Neonatal; Neurons; Neurophysiology - biologic function; Omega-3 Fatty Acids; Outcome; Pathway interactions; Patient Self-Report; Perinatal; Placebos; Polyunsaturated Fatty Acids; Poverty; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prenatal Nutrition; Prevention; Preventive Intervention; Psychosocial Stress; Public Health; Randomized; Randomized Controlled Trials; Recovery; Recruitment Activity; Regulation; Reporting; Research; Research Design; Research Personnel; Role; Side; Signal Transduction; Soybean Oil; Stress; Supplementation; TNF gene; Temperament; Testing; Time; Universities; Vulnerable Populations; Woman; Work; base; biological adaptation to stress; delivery complications; emotional distress; environmental stressor; experience; fatty acid supplementation; health disparity; high risk; hypothalamic-pituitary-adrenal axis; improved; improved outcome; infant outcome; inflammatory marker; innovation; intervention effect; member; negative affect; neonatal outcome; neurodevelopment; neurogenesis; neurotransmitter uptake; next generation; nutrition; nutritional supplementation; offspring; postnatal; pregnant; prenatal; prenatal exposure; prenatal stress; professor; programs; psychological stressor; public health relevance; receptor function; response; stress reactivity; stressor; transmission process; urban poverty

 DESCRIPTION (provided by applicant): Pregnant women living in poverty often experience chronic stress and consequently higher levels of stress hormones. In utero exposure to high levels of stress hormones can negatively affect the developing fetus and the infant's capacity for emotion and behavioral regulation. In this application we describe a developing program of research designed to reduce the negative impact of prenatal stress on infant health and development via nutritional supplementation of docosahexaenoic acid (DHA) during pregnancy. DHA is a long-chain polyunsaturated fatty acid member of the omega-3 fatty acid family. DHA is found in its highest concentrations in neural cell membranes, affecting receptor function, neurotransmitter uptake, and signal transmission. There is growing evidence that low levels of dietary DHA intake are associated with suboptimal response to stress and that DHA supplementation can modulate stress response. Aims: The goals of the proposed study are to test whether DHA supplementation during pregnancy is associated with 1) improved maternal health during pregnancy among African American women living in urban poverty; 2) improved infant birth and neurodevelopmental outcomes, and 3) whether the association between DHA supplementation during pregnancy and infant outcomes is partially mediated by reductions in maternal perceived stress and stress reactivity during pregnancy. Approach: One hundred sixty-two pregnant African American women living in urban poverty, who consume less than two servings of fish per week, will be randomly assigned to receive 450 mg/daily of DHA or placebo beginning at 9-12 weeks of gestation through the end of pregnancy. Perceived stress, stressful life events, anxiety, and depression, inflammatory markers, DHA levels and response to a laboratory stressor will be assessed at baseline and at 24, 30, and 36 weeks of pregnancy. Neonatal outcomes (e.g., gestational age, birth weight, delivery complications) will be collected from medical records, and infant neurodevelopmental outcomes and stress reactivity will be assessed at 1, 4 and 9 months of age. Investigators: This application builds on a recently completed NICHD/NIMH funded R21 (PI: Keenan), which yielded preliminary evidence that DHA supplementation during pregnancy reduces perceived stress and cortisol response to stress in pregnant African American women living in low-income, urban environments. Drs. Keenan and Hipwell and Ms. Wroblewksi were investigators on the R21 and will continue to work together on the proposed study. Dr. Della Torre is an Assistant Professor of Obstetrics at the University of Chicago, who specializes in providing clinical services to African American women living in the south side of Chicago. Innovation: This will be the first large randomized controlled study of the effect of DHA supplementation in pregnant African American women living in urban poverty on maternal and infant health and stress response. Impact: If DHA supplementation is associated with reductions in perceived stress, more modulated maternal cortisol response to stress, and more optimal emotional and behavioral regulation in the infant, even within the context urban poverty, then a comprehensive program of research on the mechanisms by which these associations evolve can be launched and broad-based prevention interventions that target maternal and child in vulnerable populations can be implemented, potentially leading to reductions health disparities in the U.S.

 描述（由应用程序提供）：生活在贫困中的孕妇经常会经历慢性压力，从而较高的压力激素水平。在子宫内暴露于高水平的压力激素可能会对发育中的胎儿以及婴儿的情绪和行为调节能力产生负面影响。在本应用程序中，我们描述了一项开发的研究计划，旨在减少产前压力对婴儿健康和发育的负面影响，这是通过补充二十二碳六烯酸（DHA）在怀孕期间的营养。 DHA是Omega-3脂肪酸家族的长链多不饱和脂肪酸成员。在神经元细胞膜中发现了DHA的浓度最高，影响受体功能，神经递质摄取和信号传播。越来越多的证据表明，低水平的饮食DHA摄入量与对压力的次级反应有关，并且补充DHA可以调节压力反应。目的：拟议的研究的目标是测试怀孕期间的补充DHA是否与1）在城市贫困中的非裔美国妇女怀孕期间怀孕期间的健康状况有所改善； 2）改善了婴儿的出生和神经发育结果，以及3）在怀孕期间补充DHA与婴儿结局之间的关联是否部分是由于孕妇感知的压力和怀孕期间的压力反应的降低而介导的。方法：居住在城市贫困中的一百六十二名孕妇妇女每周少于两份鱼类食用，她将随机分配在妊娠结束时妊娠9-12周开始接受450 mg/DHA或安慰剂。将在基线和怀孕的24、30和36周时评估压力，压力性生活事件，焦虑和抑郁，炎症标记，DHA水平以及对实验室压力源的反应。新生儿结局（例如，胎龄，出生体重，分娩并发症）将从病历中收集，婴儿神经发育结果和压力反应性将在1、4和9个月大时评估。研究人员：该应用是建立在最近完成的NICHD/NIMH资助的R21（PI：Keenan）的基础上的，该申请表明，怀孕期间补充DHA可减少居住在低收入城市环境中的怀孕的非洲裔美国妇女的压力和皮质醇对压力的感知压力和皮质酚对压力的反应。博士。 Keenan和Hipwell和Wroblewksi女士是R21的研究人员，并将继续在拟议的研究上共同努力。德拉·托雷（Della Torre）博士是芝加哥大学妇产科助理教授，他专门为居住在芝加哥南侧的非裔美国妇女提供临床服务。创新：这将是对补充DHA在城市贫困中对遗产和婴儿健康和压力反应的孕妇孕妇妇女的影响的首次大型随机对照研究。影响：如果补充DHA与减轻感知压力的减轻，对压力的更调制皮质醇的反应以及婴儿的最佳情绪和行为调节，即使在城市贫困中，甚至在城市贫困的情况下，甚至在城市贫困的情况下进行了全面的研究计划，那么对这些缔合的机制的全面研究可以启动，并且可以实现这些相关性，从而实现了对预防介绍的范围，从而实现了对杂物的范围，以实现跨性别的孩子的范围。在美国