Maternal Resilience to Stress, Neonatal Outcomes, and Racial/Ethnic Health Disparities

母亲对压力、新生儿结局和种族/民族健康差异的抵抗力

• 批准号: 10396649
• 负责人: Diana C Montoya-Williams
• 金额: $ 15.87万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10396649
• 关键词: Acculturation; Acute; Address; Award; Birth; Birth Place; Birth Weight; Breast Feeding; Buffers; Cardiovascular Diseases; Cardiovascular system; Caring; Child Traumatic Stress; Chronic; Chronic stress; Clinic; Complex; Cultural Backgrounds; Data; Development Plans; Diabetes Mellitus; Enrollment; Epidemiology; Ethnic Origin; Event; Exhibits; First Pregnancy Trimester; Foundations; Future; Goals; Hispanic; Immigrant; Immunologic Markers; Infant; Infant Mortality; Intervention; Knowledge; Length; Link; Literature; Longitudinal Studies; Longitudinal cohort; Longitudinal cohort study; Low Birth Weight Infant; Maternal Mortality; Measures; Mediator of activation protein; Mentors; Mentorship; Metabolic; Minority Women; Nature; Neonatal; Outcome; Participant; Pathologic; Pattern; Persons; Physiological; Plant Roots; Population; Pregnancy; Pregnant Women; Premature Birth; Premature Labor; Prenatal care; Prospective cohort; Psychosocial Stress; Race; Reporting; Research; Research Personnel; Risk; Role; Scientist; Secondary to; Socioeconomic Factors; Stress; System; Techniques; Testing; Training; Trauma; Woman; Work; acute stress; allostatic load; career; career development; development policy; early pregnancy; ethnic health disparity; experience; health disparity; hispanic community; improved; improved outcome; innovation; maternal stress; neonatal health; neonatal outcome; patient population; perceived stress; perinatal health; perinatal period; pregnant; psychosocial; racial and ethnic; racial and ethnic disparities; resilience; response; skills; stress resilience; stressor; therapy development; time use; tool

PROJECT SUMMARY Training: The purpose of this K23 proposal is to prepare Dr. Diana Montoya-Williams for a career as an independent clinician scientist. Her long-term career objectives are to contribute to the development of policies and interventions that diminish health disparities among pregnant minority women and their infants. Her immediate goal is to obtain the knowledge and skills to complete rigorous longitudinal studies of maternal-infant dyads aimed at defining assets that protect women against adverse neonatal outcomes. To meet these goals, Dr. Montoya-Williams and her mentor team have devised a career development plan that integrates: 1) intensive mentorship from successful investigators; 2) focused training in longitudinal cohort and statistical path analyses; and 3) innovative research on the relationship between resilience, stress and adverse neonatal outcome disparities. Research: Significant racial, ethnic and nativity-related disparities exist for birth weight, gestational length and breastfeeding in the U.S. and have major implications for our elevated infant mortality rates. Maternal psychosocial stress has been linked to these adverse neonatal outcomes and is disproportionately experienced by minority women. Resilience is the ability to respond to stress and appears to change in the face of stressors. Higher resilience has been linked to improved outcomes in conditions like diabetes and cardiovascular disease; there is also evidence that resilience can be improved. However, our knowledge of resilience in pregnancy is scarce and a major limitation is the cross-sectional nature of existing data. It is not clear whether resilience changes through the course of pregnancy and whether it modifies the relationship that exists between maternal stress and adverse neonatal outcomes. In addition, resilience may vary by race, ethnicity and nativity but data is limited. Dr. Montoya-Williams’ mentored research will address these key knowledge gaps. By creating a diverse longitudinal cohort of pregnant women, she will: 1) explore the association between resilience, three different types of perceived self-reported stress (acute, intermediate chronic and remote traumatic) and the physiologic manifestations of stress (i.e. allostatic load) at the onset of pregnancy; 2) describe whether resilience measured repeatedly in pregnancy changes in response to acute pregnancy-related stressors; and 3) investigate associations between the trajectory of resilience in pregnancy and adverse neonatal outcomes. Importantly, she will describe any differences that may exist in these relationships for women of different ethnoracial and cultural backgrounds. Summary: Findings from this study will inform an R01 proposal to test resilience interventions that may mitigate the stress-related drivers of neonatal health disparities. Through this award, Dr. Montoya-Williams will also emerge as a leading independent clinician scientist contributing to the amelioration of neonatal racial/ethnic health disparities.

项目概要 培训：此 K23 提案的目的是为 Diana Montoya-Williams 博士的职业生涯做好准备 她的长期职业目标是为独立临床科学家的发展做出贡献。 缩小少数族裔怀孕妇女及其婴儿健康差距的政策和干预措施。 她的近期目标是获得知识和技能来完成严格的纵向研究 母婴二元关系旨在确定保护妇女免受不良新生儿后果影响的资产。 为了实现这些目标，蒙托亚-威廉姆斯博士和她的导师团队制定了职业发展计划 其中包括：1）成功研究者的强化指导；2）纵向集中培训； 队列和统计路径分析；3）关于复原力之间关系的创新研究， 压力和不良新生儿结局差异。 研究：出生体重、妊娠长度存在显着的种族、民族和出生相关差异 和母乳喂养对美国的婴儿死亡率升高有重大影响。 社会心理压力与这些不良新生儿结局有关，并且不成比例地 少数族裔妇女所经历的复原力是指应对压力的能力，并且似乎会随着环境的变化而变化。 面对压力源，更高的适应力与改善糖尿病和糖尿病等疾病的结果有关。 心血管疾病；也有证据表明恢复能力是可以提高的。 怀孕期间的复原力很少，主要限制是现有数据的横截面性质。 尚不清楚弹性是否会在怀孕过程中发生变化以及是否会改变 此外，母亲压力与不良新生儿结局之间存在关系。 可能因种族、民族和出生地而异，但蒙托亚-威廉姆斯博士指导的研究数据有限。 通过创建一个多样化的纵向孕妇队列，她将解决这些关键的知识差距： 1) 探索复原力与三种不同类型的自我报告压力（急性、 中度慢性和远期创伤）和压力的生理表现（即稳态负荷） 2) 描述怀孕期间反复测量的弹性是否发生变化 对与妊娠相关的急性应激源的反应；3) 研究妊娠轨迹之间的关联。 重要的是，她将描述妊娠的恢复力和不良的新生儿结局。 对于不同种族和文化背景的妇女来说，这些关系中可能存在。 摘要：这项研究的结果将为 R01 提案提供信息，以测试可能的弹性干预措施 蒙托亚-威廉姆斯博士通过该奖项减轻了与压力相关的新生儿健康差异的驱动因素。 还将成为一位领先的独立临床科学家，为改善新生儿疾病做出贡献 种族/民族健康差异。