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.

项目摘要 培训：该K23提案的目的是为Diana Montoya-Williams博士准备职业 独立的临床科学家。她的长期职业目标是为发展 政策和干预措施减少了怀孕少数妇女及其婴儿的健康差异。 她的直接目标是获得知识和技能，以完成严格的纵向研究 旨在定义保护妇女免受不良新生儿结局的资产的旨在定义的二元组。到 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 整合：1）成功调查人员的密集程度； 2）纵向的重点训练 队列和统计路径分析； 3）关于弹性之间关系的创新研究， 压力和不良新生儿结果差异。 研究：出生体重，妊娠长度存在重要的种族，种族和诞生相关的分布 并在美国进行母乳喂养，并对我们的婴儿死亡率升高具有重大影响。母亲 社会心理压力与这些不良新生儿结果有关，并且不成比例 由少数民族妇女经历。弹性是应对压力的能力，并且似乎改变了 面部压力源。在糖尿病和 心血管疾病；也有证据表明可以提高弹性。但是，我们对 怀孕的弹性是稀缺的，主要限制是现有数据的横断面性质。这是 尚不清楚弹性是否在怀孕过程中发生变化，以及它是否会改变 在母校压力和不良新生儿结局之间存在的关系。另外，弹性 可能因种族，种族和诞生而有所不同，但数据有限。蒙托亚·威廉姆斯博士的指导研究威尔 解决这些关键知识差距。通过创建潜水员的纵向孕妇队列，她将： 1）探索弹性之间的关联，三种不同类型的自我报告的压力（急性， 中间的慢性和远程创伤）以及压力的生理表现（即同性恋负荷） 怀孕开始； 2）描述是否在妊娠变化中反复测量弹性 对与急性妊娠相关的应激源的反应； 3）研究轨迹之间的关联 怀孕和不良新生儿结局的韧性。重要的是，她将描述任何差异 这些关系可能存在于具有不同种族和文化背景的女性中。 摘要：这项研究的发现将为R01提案提供测试弹性干预措施的建议 减轻与压力相关的新生儿健康差异的驱动因素。通过这个奖项，蒙托亚·威廉姆斯博士 还将成为领先的独立临床科学家，以改善新生儿 种族/种族健康差异。