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，出生大多数先天性畸形的人的平均寿命在过去大大改善 几十年来，使大多数人能够在生殖年份中生存。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，重要的是要了解 受影响妇女的怀孕。有证据表明，具有不同的残疾定义的妇女更多 可能有婴儿出生体重低或过早的婴儿。可用的有限研究表明 这些出生结果的相关危险因素在不同的孕妇中往往更为常见 残疾与普通人群相比。例如，吸烟，饮酒和肥胖症 增加不良后果的风险，在患有 残疾。但是，迄今为止尚无研究检查与不良出生有关的怀孕暴露 身体残疾妇女的结果。在育龄的妇女中，大多数身体残疾 通常是由先天性肌肉和神经肌肉缺陷（CMND）造成的，被定义为脊柱裂，大脑 麻痹，肌肉营养不良和肢体异常（染色，缺失或缩短）。流动性障碍 敏捷会影响日常生活的活动，并导致慢性疼痛，睡眠障碍和 社会心理问题。治疗这些症状所需的药物和其他行为应对 机制可能与出生结果有关，从而进一步研究了怀孕的过程 以及受CMND的妇女的出生结果。这项研究将利用丰富的数据资源 - 波士顿大学Slone Slone流行病学中心的出生缺陷研究。从1976年到2015年，超过68,000位母亲 出生的婴儿和没有先天异常的婴儿被询问有关一系列事件的详细问题 以及怀孕期间的暴露，目的是确定出生缺陷的危险因素。女人是 特别询问他们是出生于脊柱裂还是大脑，头部，脊柱，脊髓的任何异常， 肌肉，骨头，手臂或腿部。这项研究将比较被确定为有一个的132名女性 CMND至528名未受影响的妇女在以下怀孕暴露中：吸烟，酒精摄入量，前 怀孕体重指数，补充维生素，肾脏/膀胱感染，止痛药，睡眠 药物和精神活性药物。共同不良出生结果的比较将包括 早产，低出生体重和巨糖症。此外，调解分析将测量 通过妊娠暴露介导的CMND与出生结果之间的关联。一个 估计有212,000名美国育龄妇女有一个CMND，怀孕可能需要特殊 服务。有必要了解先天性女性的怀孕和结果 身体残疾作为确保最佳护理和预防风险的一步。这个项目利用了 为此目的提供有价值的信息的独特数据资源。

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.