Advancing understanding of racism-related health disparities beginning before birth: A multisite study with Black and Latina pregnant women

增进对出生前开始的与种族主义相关的健康差异的理解：一项针对黑人和拉丁裔孕妇的多地点研究

• 批准号: 10522830
• 负责人: Sierra E Carter
• 金额: $ 69.81万
• 依托单位: GEORGIA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-07 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10522830
• 关键词: Address; Adult; Affect; African American; American; Area; Behavior; Biological; Biological Process; Biology; Birth; Black race; Blood Pressure; Buffers; Cessation of life; Child; Cities; Coping Skills; Development; Discipline of obstetrics; Discrimination; Enrollment; European; Exposure to; Family health status; Fetal Development; Fetal Heart Rate; Fetal autonomic nervous system; Fetal health; Fetus; Foundations; Future; Generations; Goals; Health; Health Care Costs; Heart Rate; Home; Hour; Hypertension; Individual; Infant; Intervention; Interview; Knowledge; Latina; Life; Literature; Longitudinal Studies; Low Birth Weight Infant; Maternal Mortality; Maternal Physiology; Measurable; Measures; Medical; Methods; Midwife; Mothers; Nature; Neurodevelopmental Problem; Newborn Infant; Outcome; Outcome Measure; Personal Satisfaction; Persons; Physiological; Physiology; Pregnancy; Pregnancy Complications; Pregnancy Trimesters; Pregnant Women; Premature Birth; Process; Protocols documentation; Psychophysiology; Qualitative Methods; Questionnaires; Reporting; Research; Review Literature; Risk; Sampling; Second Pregnancy Trimester; Sex Differences; Site; Social support; Sodium Chloride; Stress; Structure; Testing; Third Pregnancy Trimester; Time; Validation; Woman; Work; adverse birth outcomes; allostatic load; black women; care systems; cohort; diaries; dyadic interaction; early childhood; ethnic identity; experience; fetal; follow-up; healing; health disparity; health inequalities; health of the mother; heart rate variability; high risk; indexing; infant outcome; innovation; intergenerational; longitudinal design; modifiable behavior; neglect; neurobehavior; neurobehavioral; neurodevelopment; pregnant; prenatal; prenatal exposure; programs; racial and ethnic; racial discrimination; racial disparity; racial identity; racism; recruit; stress management; stress reactivity; stressor; transmission process; women of color

Descriptive Title: Advancing understanding of racism-related health disparities before birth Project Summary/Abstract Racial and ethnic injustice are prevalent and devastating causes of stress and subsequent health disparities. Black and Latina women experience a higher burden of pregnancy complications, maternal mortality, and preterm birth compared to White women. These disparities in birth outcomes are exacerbated by systems of care that neglect or invalidate the experiences of pregnant women of color, contributing to high-risk deliveries, unnecessary obstetric interventions, and death of women and infants. Yet, no studies have examined whether experiences of racism prenatally affect fetal health and development through a process of “biological embedding” of racism measured daily during pregnancy. This study will address three major gaps in the literature to date. First, experiences of racism and discrimination are often measured globally, missing the cumulative nature of stress exposure on fetal physiological development. Second, it is unclear whether specific partner behaviors (e.g., validation of racism-related experiences) and/or culturally-grounded coping strategies grounded in the Radical Healing Framework (e.g., racial/ethnic identity, activism) can buffer effects of racism on maternal physiology, fetal physiology, and birth outcomes. Third, given the novelty of this research program, it is important to integrate qualitative methods that center the experiences of Black and Latina women during this transformative and vulnerable life stage. The objective of this proposal is to advance understanding of racism-related health disparities in pregnant women and infants by (1) enrolling Black and Latina women during the 2nd and 3rd trimester of pregnancy and assessing daily racism experiences through daily diary assessments (14 consecutive days trimester); (2) measuring maternal and fetal psychophysiology during the third trimester (e.g., heart rate, heart rate variability); (3) assessing newborn neurodevelopment within 48 hours of birth; and (4) exploring culturally-grounded buffers and qualitative experiences of racism on women and infants. We will enroll 400 pregnant women from the Atlanta, GA and Salt Lake City, UT metro areas (n=200/site), using established protocols for recruiting and retaining women during this developmental stage. Participating women will complete questionnaires and a 2-week daily diary of stressors related to racism in the 2nd and 3rd trimester. In the 3rd trimester, women will complete these measures, a qualitative interview, and two weeks of in-home maternal and fetal physiological measures, which includes an innovative measure of fetal heart rate (HR) and HR variability (HRV). Women will also complete a structured interaction task with their romantic partner or closest support person; involving discussions of how each cope with racism-related stressors. Within 48 hours of birth, infants will complete the NICU Network Neurobehavioral Scale (NNNS) to assess how prenatal exposure to racism may affect newborn birth outcomes. This short-term longitudinal study lays the foundation for further follow-up of infants and women into early childhood and a programmatic line of research devoted to understanding and intervening with marginalized mothers and children to reduce the effects of racism on family health and wellbeing.

描述性标题：提高对种族有关的健康差异的理解 项目摘要/摘要 种族和种族不公正是压力和随后的健康差异的普遍和毁灭性的原因。 黑人和拉丁裔妇女的怀孕并发症，孕产妇死亡率和 与白人妇女相比，早产。这些在出生成果中的分布被 关心忽视或无效有色孕妇的经历，导致高风险分娩， 不必要的产科干预以及妇女和婴儿的死亡。但是，尚无研究检查是否 种族主义的经历会在产前影响胎儿健康和发展，从而通过“生物学 每天在怀孕期间测量的种族主义的嵌入。这项研究将解决文献中的三个主要差距 迄今为止。首先，种族主义和歧视的经历通常在全球范围内进行衡量，缺少累积 压力暴露在胎儿身体发育中的性质。其次，目前尚不清楚特定的合作伙伴是否 行为（例如，与种族主义相关的经历的验证）和/或以文化为基础的应对策略扎根于 在激进的康复框架中（例如，种族/种族身份，行动主义）可以缓冲种族主义对母亲的影响 生理学，胎儿生理和出生结果。第三，鉴于该研究计划的新颖性，这很重要 整合定性方法，以这种变革性的方式集中黑人和拉丁裔妇女的经历 和脆弱的生活阶段。该提议的目的是提高对种族主义有关的理解 （1）在第二名中招募黑人和拉丁裔妇女的孕妇和婴儿的健康差异 三个月怀孕和评估日常种族主义经历通过日记评估（14 连续孕期）； （2）测量三个月期间的母乳和胎儿心理生理学（例如 心率，心率变异性）； （3）在出生后48小时内评估新生儿神经发育； （4） 探索具有文化的缓冲区和对妇女和婴儿种族主义的定性经历。我们将注册 400名来自佐治亚州亚特兰大和盐湖城的孕妇，使用已建立 在此发展阶段招募和保留妇女的协议。参加的妇女将完成 问卷和第二个与种族主义有关的压力源的每日2周日记在第二和第三学期。在第三 妊娠中期，妇女将完成这些措施，定性采访以及两周的家庭及 胎儿身体测量，包括对胎儿心率（HR）和人力资源变异性的创新度量 （HRV）。妇女还将与浪漫伴侣或最亲密的支持完成结构化的互动任务 人;涉及讨论每个人如何应对种族相关的压力源。出生后的48小时内，婴儿 将完成NICU网络神经行为量表（NNNS），以评估产前暴露于种族主义 影响新生儿的出生结果。这项短期纵向研究为进一步跟进奠定了基础 婴儿和妇女进入幼儿，以及致力于理解和 干预边缘化的母亲和儿童，以减少种族主义对家庭健康和福祉的影响。