Iron and folic acid supplementation strategies during pregnancy and adverse pregnancy outcomes in Botswana - Resubmission - 1

博茨瓦纳怀孕期间的铁和叶酸补充策略以及不良妊娠结局 - 重新提交 - 1

• 批准号: 10012374
• 负责人: Ellen Christina Caniglia
• 金额: $ 10.07万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10012374
• 关键词: Address; Adherence; Adult; Affect; African; Anemia; Area; Berry; Birth; Botswana; Cause of Death; Child; Clinic; Clinical; Communicable Diseases; Computer Simulation; Country; Data; Demographic Factors; Education; Effectiveness; Environment; Epidemiologic Methods; Evaluation; First Pregnancy Trimester; Folic Acid; Formulation; Geographic Factor; Geographic Locations; Gestational Age; Goals; Guidelines; HIV; HIV Seronegativity; HIV Seropositivity; Health Benefit; Health system; Income; Individual; Infant; International; Intervention; Intervention Studies; Interview; Iron; Knowledge; Link; Literature; Low Birth Weight Infant; Malaria; Malnutrition; Maternal and Child Health; Measures; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Micronutrients; Modification; Neural Tube Defects; Newborn Infant; Outcome; Pharmaceutical Preparations; Policies; Population; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Proxy; Qualitative Evaluations; Qualitative Methods; Qualitative Research; Reading; Recommendation; Research; Research Personnel; Research Project Grants; Resources; Risk; Risk Factors; Sampling; Science; Sepsis; Small for Gestational Age Infant; Structure; Subgroup; Supplementation; Testing; Time; Training; Underserved Population; Underweight; United Nations; Woman; Work; World Health Organization; adverse pregnancy outcome; antenatal; antenatal care; base; career; career development; community organizations; compare effectiveness; cost effective; data infrastructure; design; effective intervention; experience; folic acid supplementation; fortification; high risk; high risk population; improved; iron deficiency; maternal weight; medical schools; prenatal; prevent; programs; research and development; side effect; stillbirth; surveillance data; surveillance study; symposium; therapy development; treatment strategy; uptake

PROJECT SUMMARY Background. The risk of stillbirth, preterm delivery, low birthweight and other adverse pregnancy outcomes is extremely high in Sub-Saharan African countries including Botswana, especially among HIV-positive women. Daily iron and folic acid supplementation during pregnancy could reduce adverse pregnancy outcomes by reducing maternal anemia. However, the effectiveness of supplementation in subgroups defined by HIV status, anemia, gestational age, and other clinical, demographic and geographic factors remains unknown and compliance with supplementation guidelines is variable (<50% in Botswana). Cost-effective interventions to provide supplementation to pregnant women in Botswana and other resource-limited settings should be designed to address key barriers to successful supplementation and to reach subgroups that would benefit most from intervention. This K01 provides a unique opportunity to address this gap in the literature. Candidate Overview. My long-term career objective is to become an independent investigator who specializes in interventions to improve maternal and child health in resource-limited settings. My background is in applications of epidemiologic methods to evaluate effects of HIV treatment strategies in adults and infants. A K01 award will provide the necessary additional training and experience needed to become an expert in the design, implementation, and evaluation of interventions to improve pregnancy outcomes in HIV-positive women and underserved populations. Career Development and Training Plan. My education program includes structured course work, professional conferences, directed readings, and a research project with specific aims timed to coincide with these activities. My mentorship team includes international experts who specialize in areas related to my training goals: Dr. Scott Braithwaite (decision science), Dr. Roger Shapiro (HIV and maternal and child health in Botswana), Dr. Donna Shelley (intervention development and implementation), and Dr. Carolyn Berry (qualitative methods). Environment. NYU School of Medicine provides an exceptional environment for me to conduct the proposed study, obtain additional training and mentorship, and successfully transition to an independent investigator. Research Strategy. Using the data and infrastructure from an ongoing birth outcomes surveillance study in Botswana consisting of data from over 130,000 births, my study will: 1) estimate the effect of iron and folic acid supplementation during pregnancy on adverse pregnancy outcomes by HIV status, anemia, gestational age, and other key subgroups to identify populations that would benefit most from intervention; 2) assess barriers to supplementation during and prior to pregnancy; 3) optimize a hypothetical intervention to provide supplementation using computer simulation; and 4) develop and test the feasibility of an intervention to provide supplementation to pregnant women in Botswana.

项目概要 背景。死产、早产、低出生体重和其他不良妊娠结局的风险是 在包括博茨瓦纳在内的撒哈拉以南非洲国家，尤其是艾滋病毒呈阳性的妇女中，这一比例极高。 怀孕期间每日补充铁和叶酸可以减少不良妊娠结局 减少孕产妇贫血。然而，补充在由艾滋病毒状况定义的亚组中的有效性， 贫血、胎龄和其他临床、人口和地理因素仍然未知， 对补充指南的遵守情况各不相同（博茨瓦纳<50%）。具有成本效益的干预措施 应为博茨瓦纳和其他资源有限地区的孕妇提供补充品 旨在解决成功补充的主要障碍并惠及受益的亚群体 大部分来自干预。 K01 提供了一个独特的机会来解决文献中的这一空白。 候选人概述。我的长期职业目标是成为一名专门从事研究的独立调查员 采取干预措施改善资源有限环境中的孕产妇和儿童健康。我的背景是在 应用流行病学方法评估成人和婴儿艾滋病毒治疗策略的效果。一个 K01 奖项将提供成为该领域专家所需的额外培训和经验 设计、实施和评估干预措施，以改善艾滋病毒阳性者的妊娠结局 妇女和服务不足的人群。 职业发展和培训计划。我的教育计划包括结构化课程作业， 专业会议、定向阅读和具有特定目标的研究项目，时间与 这些活动。我的导师团队包括专门研究与我相关领域的国际专家 培训目标：Scott Braithwaite 博士（决策科学）、Roger Shapiro 博士（艾滋病毒和妇幼健康） 博茨瓦纳）、Donna Shelley 博士（干预措施制定和实施）和 Carolyn Berry 博士 （定性方法）。 环境。纽约大学医学院为我提供了一个特殊的环境来进行拟议的 研究，获得额外的培训和指导，并成功过渡为独立研究者。 研究策略。使用正在进行的出生结果监测研究的数据和基础设施 博茨瓦纳包含超过 130,000 名新生儿的数据，我的研究将： 1) 估计铁和叶酸的作用 怀孕期间补充补充剂对艾滋病毒状况、贫血、孕龄等不良妊娠结局的影响 和其他关键亚组，以确定最能从干预中受益的人群； 2）评估障碍 怀孕期间和怀孕前补充； 3）优化假设的干预措施以提供 使用计算机模拟进行补充； 4) 制定并测试干预措施的可行性，以提供 博茨瓦纳孕妇补充剂。