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

• 批准号: 10087967
• 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
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-19 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10087967
• 关键词: Address; Affect; Area; Asians; Biological; Birth; 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; Hispanics; 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; 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; Address; Affect; Area; Asians; Biological; Birth; 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; Hispanics; 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; 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

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 严重的孕产妇发病率（SMM）包括对分娩或产后发生的物物健康和生存的严重威胁。基于CDC开发的SMM指数，该指数侧重于最威胁生命的状况和并发症，SMM的患病率从1998 - 2011年增加了一倍，目前每年在美国影响> 65,000名妇女。孕产妇的健康对于女性照顾孩子的能力和对她的生活课程的健康至关重要，但是我们对SMM原因的理解是有限的。该提案介绍了SMM的三个关键和理解的研究领域：种族/种族差异，孕产妇体重和社会灾难。 SMM及其贡献条件的种族/种族差异是众所周知的 - 非西班牙裔黑人的SMM风险往往高达2倍，而在西班牙裔和亚洲人中，相对于非西班牙裔白人，SMM的风险往往高出1.5倍。这些分布的解释尚不清楚，但初步 有证据表明，物质体重和社会灾难可能会造成任何贡献。在美国，有25％的妇女肥胖，怀孕期间的体重超过一半，而25％的产后> 10磅，但这因种族种族而有所不同。一些研究表明，肥胖与SMM的关联，但很少有人检查了肥胖，体重不足或体重变化的严重程度。与白人相比，社会灾难在非白人中更为普遍，并且与无数的围产期结局有关，但是几乎没有研究检查其对SMM的贡献。在社会不利的妇女中，异常高和低的产妇体重和体重增加很可能是在社会上处于不利地位的妇女，但她们对SMM的相关影响尚未研究。我们的目标是通过分析2007 - 2014年在加利福尼亚州发生的400万个出生，以提高对SMM及其种族/种族差异的生物学和社会决定者的了解。数据包括生命记录以及母亲和婴儿医院出院数据，从怀孕到产后。结局将包括有助于SMM的最常见疾病 - 产后出血，Eclampsia/Recary先兆子痫，精选心血管疾病和败血症 - 以及CDC开发的SMM指数。 具体目的是：1）检查孕产妇体重状况的关联 患有SMM的怀孕以及是否通过种族/种族来修改； 2）检查社会灾难与SMM，整体和种族/种族（AIM 2A）的多层次（个人，家庭，社区）指标的关联，以及这些关系是由物质体重状况介导的（AIM 2B）的程度； 3）研究孕产妇体重状况和社会灾难对SMM燃烧及其种族/种族差异的贡献。拟议的研究将通过研究母校体重，社会灾难，种族/族裔分布和SMM之间的复杂关系来打破新的基础。这些知识对于开发有效的公共卫生和临床干预措施至关重要，以减少SMM及其分布，包括有关母子体重的准则。