Severe Maternal Morbidity: An Investigation of Racial-Ethnic Disparities, Social Disadvantage & Maternal Weight

严重的孕产妇发病率：对种族差异、社会弱势的调查

基本信息

批准号：
10300988
负责人：
SUZAN L CARMICHAEL
金额：
$ 54.18万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-01-19 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10300988
关键词：
Address Affect Area Asian population Biological Birth Black Populations Body Weight Changes Body mass index California Cardiovascular system Categories Censuses Centers for Disease Control and Prevention (U.S.)Child Care Clinical Code Complex Conceptions Data Development Disadvantaged Eclampsia Ethnic Origin Future Gestational Age Goals Guidelines Health Hispanic Populations Hospital Records Hospitals Household ICD-9 Individual Infant Intervention Investigation Knowledge Life Life Cycle Stages Link Maternal Health Mediating Methods Morbid Obesity Mothers Multiple Pregnancy Neighborhoods Not Hispanic or Latino Obesity Outcome Population Postpartum Hemorrhage Postpartum Period Pre-Eclampsia Pregnancy Prevalence Public Health Race Records Research Risk Sepsis Severities Standardization Underweight Weight Gain Woman base cost disadvantaged women excessive weight gain gestational weight gain high risk indexing maternal weight perinatal health perinatal outcomes prepregnancy racial and ethnic disparities severe maternal morbidity social social determinants social disadvantage

项目摘要

ABSTRACT Severe Maternal Morbidity (SMM) includes serious threats to maternal health and survival that occur at delivery or postpartum. Based on the SMM index developed by CDC that focuses on the most life-threatening conditions and complications, the prevalence of SMM doubled from 1998-2011 and currently affects >65,000 women in the U.S. each year. Maternal health is essential to a woman’s ability to care for her children and to her health over her life course, yet our understanding of causes of SMM is limited. This proposal addresses three key and understudied areas of research for SMM: racial/ethnic disparities, maternal weight, and social disadvantage. Racial/ethnic disparities in SMM and its contributing conditions are well known – risk of SMM tends to be up to 2-fold higher among non-Hispanic blacks and 1.5-fold higher among Hispanics and Asians, relative to non-Hispanic whites. The explanation for these disparities is unknown, but preliminary evidence suggests that maternal weight and social disadvantage may contribute. In the U.S., 25% of women are obese at conception, half gain excessive weight during pregnancy, and 25% retain >10 lb. postpartum, but this varies by race-ethnicity. Some studies suggest an association of obesity with SMM, but few have examined severity of obesity, underweight status, or weight change. Social disadvantage is much more common among non-whites than whites and associated with myriad perinatal outcomes, but almost no studies have examined its contribution to SMM. Unusually high and low maternal weight and weight gain are most likely among socially disadvantaged women, but their inter-related impacts on SMM have not been studied. Our goal is to increase understanding of biologic and social determinants of SMM and its racial/ethnic disparities, by analyzing 4 million births that occurred in California from 2007-2014. The data include vital records and mother and infant hospital discharge data from pregnancy through postpartum. Outcomes will include the most common conditions that contribute to SMM – postpartum hemorrhage, eclampsia/severe preeclampsia, select cardiovascular conditions, and sepsis – as well as the SMM index developed by CDC. The Specific Aims are: 1) Examine associations of maternal weight status before, during, and between pregnancies with SMM and whether they are modified by race/ethnicity;; 2) Examine associations of multi-level (individual, household, neighborhood) indicators of social disadvantage with SMM, overall and by race/ethnicity (Aim 2a), and the extent to which these relationships are mediated by maternal weight status (Aim 2b);; and 3) Investigate the contribution of maternal weight status and social disadvantage to the population burden of SMM and its racial/ethnic disparities. The proposed research will break new ground by studying the complex relationships among maternal weight, social disadvantage, racial/ethnic disparities, and SMM. This knowledge is essential to the development of effective public health and clinical interventions to reduce SMM and its disparities, including guidelines for maternal weight.

抽象的严重孕产妇发病率 (SMM) 包括在分娩或产后发生的对孕产妇健康和生存的严重威胁。根据 CDC 制定的专注于最危及生命的病症和并发症的 SMM 指数，SMM 的患病率从 1998 年到 2011 年翻了一番。目前每年影响美国超过 65,000 名女性。孕产妇健康对于女性照顾孩子的能力及其一生的健康至关重要，但我们对原因的了解却很重要。该提案涉及 SMM 的三个关键和未充分研究的领域：种族/民族差异、母亲体重和 SMM 中的社会劣势及其影响因素是众所周知的——SMM 的风险往往是。相对于非西班牙裔白人，非西班牙裔黑人的这一比例高出 2 倍，西班牙裔和亚洲人则高出 1.5 倍。这些差异的解释尚不清楚，但是初步的。有证据表明，在美国，25% 的女性在怀孕时体重增加过多，25% 的女性在产后体重仍超过 10 磅，但这因种族而异。研究表明肥胖与 SMM 存在关联，但很少有人研究过肥胖的严重程度、体重不足状况或体重变化在非白人中比白人更常见，并且与多种围产期结局相关，但几乎没有研究。已经研究了其对 SMM 的影响。异常高和低的母亲体重和体重增加最有可能发生在社会弱势妇女中，但它们对 SMM 的相互关联的影响尚未得到研究。通过分析 2007 年至 2014 年加利福尼亚州的 400 万新生儿，这些数据包括从怀孕到产后的重要记录和母婴出院数据，以了解其种族/民族差异。导致 SMM（产后出血、子痫/严重先兆子痫、特定心血管疾病和败血症）以及 CDC 制定的 SMM 指数。具体目标是： 1) 检查产前、产中和产间之间母亲体重状况的关联性 SMM 怀孕情况以及它们是否因种族/民族而改变； 2) 检查总体上和按种族/民族划分的多层次（个人、家庭、邻里）社会劣势指标与 SMM 的关联（目标 2a）及其程度这些关系是由母亲体重状况调节的（目标 2b）；以及 3) 调查母亲体重状况和社会劣势对 SMM 人口负担及其种族/民族的影响拟议的研究将通过研究母亲体重、社会劣势、种族/民族差异和 SMM 之间的复杂关系来开辟新的领域，这些知识对于制定有效的公共卫生和临床干预措施以减少 SMM 及其影响至关重要。差异，包括孕产妇体重指南。