Pregnancy in women with congenital physical disabilities: Risk factors, birth outcomes, and mediation

先天性身体残疾妇女的怀孕：危险因素、出生结局和调解

• 批准号: 9883035
• 负责人: MARTHA M. WERLER
• 金额: $ 8.25万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9883035
• 关键词: Activities of Daily Living; Address; Affect; Alcohol consumption; Analgesics; Behavioral; Birth; Birth Weight; Birthing Centers; Body mass index; Boston; Brain; Caring; Cerebral Palsy; Characteristics; Child; Congenital Abnormality; Contracture; Data; Defect; Demographic Factors; Ensure; Epidemiology; Event; Family; Female of child bearing age; Fertility; General Population; Gestational Age; Head; Impairment; Individual; Infective cystitis; Interview; Kidney; Leg; Limb structure; Longevity; Low Birth Weight Infant; Measures; Mediating; Mediation; Mothers; Muscle; Muscular Dystrophies; National Institute of Child Health and Human Development; Obesity; Outcome; Pharmaceutical Preparations; Population; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prevention; Reporting; Reproductive History; Research; Risk; Risk Factors; Services; Site; Sleep; Sleep disturbances; Spinal Cord; Spinal Dysraphism; Supplementation; Universities; Vertebral column; Vitamins; Weight; Woman; adverse birth outcomes; adverse outcome; arm; base; bone; chronic pain; cigarette smoking; congenital anomaly; coping mechanism; data resource; dexterity; disability; improved; neuromuscular; physically handicapped; premature; prepregnancy; psychosocial; reproductive; response; stem; symptom treatment; women with disabilities

The average lifespan of individuals born with most congenital malformations has vastly improved in the past decades, allowing the majority to survive through the reproductive years. Because the presence of a physical disability typically does not affect fertility or the desire for a family, it is important to understand the course of pregnancy among affected women. Evidence shows that women with varying definitions of disability are more likely to have babies born with low birth weights or prematurely. The limited research available suggests that relevant risk factors for these birth outcomes tend to be more common in pregnant women with varying disabilities compare to the general population. For example, cigarette smoking, alcohol drinking, and obesity increase risks of adverse outcomes and appear to be disproportionately higher in pregnant women with disabilities. However no study to date has examined pregnancy exposures in relation to adverse birth outcomes among women with physical disabilities. In women of childbearing ages, physical disabilities most often stem from congenital muscular and neuromuscular defects (cMND), defined as spina bifida, cerebral palsy, muscular dystrophy, and limb anomalies (contractures, missing or shortened). Impairments in mobility and dexterity can impact activities of daily living and result in chronic pain, sleep disturbances, and psychosocial problems. Medications needed for the treatment of these symptoms, and other behavioral coping mechanisms, may be associated with birth outcomes, raising further the need to study the course of pregnancy and birth outcomes among cMND-affected women. This study will take advantage of rich data resource - the Boston University Slone Epidemiology Center Birth Defects Study. From 1976 to 2015, over 68,000 mothers of babies born with and without congenital anomalies were asked detailed questions about a range of events and exposures during pregnancy for the purpose of identifying risk factors for birth defects. Women were specifically asked if they were born with spina bifida or any anomalies of the brain, head, spine, spinal cord, muscles, bones, arms, or legs. This study will compare the 132 women who were identified as having a cMND to 528 unaffected women for the following pregnancy exposures: cigarette smoking, alcohol intake, pre- pregnancy body mass index, vitamin supplementation, kidney/bladder infection, pain medications, sleep medications, and psychoactive medications. Comparisons of common adverse birth outcomes will include premature birth, low birth weight, and macrosomia. In addition, mediation analyses will measure the amount of an association between cMND and birth outcomes that is mediated through pregnancy exposures. An estimated 212,000 US women of childbearing ages have a cMND, for whom pregnancy may require special services. It is necessary to understand the course of pregnancy and outcomes among women with congenital physical disabilities as a step toward ensuring optimal care and risk prevention. This project takes advantage of a unique data resource to provide valuable information for this purpose.

过去，患有大多数先天畸形的人的平均寿命已大大提高 数十年，使大多数人能够度过生育年龄。因为身体的存在 残疾通常不会影响生育能力或对家庭的渴望，了解残疾的过程很重要 受影响的妇女怀孕。有证据表明，具有不同残疾定义的女性更容易 可能会生出低出生体重或早产的婴儿。现有的有限研究表明 这些出生结果的相关危险因素往往在不同年龄的孕妇中更为常见。 与普通人群相比的残疾。例如，吸烟、饮酒和肥胖 增加不良后果的风险，并且在患有以下疾病的孕妇中似乎不成比例地更高 残疾。然而，迄今为止还没有研究检查妊娠暴露与不良分娩的关系 身体残疾妇女的结果。在育龄妇女中，身体残疾最常见 通常源于先天性肌肉和神经肌肉缺陷（cMND），定义为脊柱裂、脑裂 麻痹、肌营养不良和肢体异常（挛缩、缺失或缩短）。行动不便 灵活性会影响日常生活活动并导致慢性疼痛、睡眠障碍和 心理社会问题。治疗这些症状和其他行为应对所需的药物 机制，可能与出生结果有关，进一步提高了研究妊娠过程的必要性 以及受 cMND 影响的妇女的出生结局。本研究将利用丰富的数据资源—— 波士顿大学斯隆流行病学中心出生缺陷研究。从 1976 年到 2015 年，超过 68,000 名母亲 出生时患有或不患有先天异常的婴儿被问及有关一系列事件的详细问题 和怀孕期间的暴露，以确定出生缺陷的危险因素。女性是 特别询问他们是否出生时患有脊柱裂或大脑、头部、脊柱、脊髓的任何异常， 肌肉、骨骼、手臂或腿。这项研究将比较 132 名被确定患有 cMND 对 528 名未受影响的女性进行了以下怀孕暴露：吸烟、饮酒、孕前暴露 怀孕体重指数、维生素补充、肾/膀胱感染、止痛药、睡眠 药物和精神活性药物。常见不良分娩结局的比较包括 早产、低出生体重和巨大儿。此外，中介分析将衡量 cMND 与出生结果之间的关联是通过妊娠暴露介导的。一个 据估计，有 212,000 名美国育龄妇女患有慢性运动神经元病 (cMND)，对她们来说，怀孕可能需要特殊的治疗 服务。有必要了解患有先天性疾病的妇女的妊娠过程和结局 身体残疾是确保最佳护理和风险预防的一个步骤。该项目利用了 独特的数据资源为此目的提供有价值的信息。

项目成果

Birth outcomes among women with congenital neuromuscular disabilities.

• DOI: 10.1016/j.dhjo.2021.101259
• 发表时间: 2022-04
• 期刊: Disability and health journal
• 影响因子: 4.5
• 作者: Huezo García M;Parker SE;Petersen JM;Rubenstein E;Werler MM
• 通讯作者: Werler MM

Medication use during pregnancy among women with congenital physical disabilities.

• DOI: 10.1002/bdr2.2048
• 发表时间: 2022-08-15
• 期刊: BIRTH DEFECTS RESEARCH
• 影响因子: 2.1
• 作者: Garcia, Michelle Huezo;Petersen, Julie M.;Parker, Samantha E.;Rubenstein, Eric;Werler, Martha M.
• 通讯作者: Werler, Martha M.