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: 10091301
• 负责人: SUZAN L CARMICHAEL
• 金额: $ 20.08万
• 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/10091301
• 关键词: Address; Affect; Area; Asians; Biological; Birth; Body Weight Changes; California; Cardiovascular system; Centers for Disease Control and Prevention (U.S.); Child Care; Clinical; Complex; Conceptions; Data; Development; Eclampsia; Ethnic Origin; Future; Goals; Guidelines; Health; Hispanics; Hospitals; Household; Individual; Infant; Intervention; Investigation; Knowledge; Life; Life Cycle Stages; Maternal Health; Mediating; Mothers; Neighborhoods; Not Hispanic or Latino; Obesity; Outcome; Population; Postpartum Hemorrhage; Postpartum Period; Pre-Eclampsia; Pregnancy; Prevalence; Public Health; Race; Records; Research; Risk; Sepsis; Severities; Underweight; Weight; Weight Gain; Woman; base; high risk; indexing; maternal weight; parent grant; perinatal outcomes; racial and ethnic disparities; severe maternal morbidity; social determinants; social disadvantage

ABSTRACT (from parent grant R01 NR017020) 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.

摘要（来自家长拨款 R01 NR017020） 严重孕产妇发病率 (SMM) 包括对孕产妇健康和生存造成的严重威胁 基于 CDC 开发的 SMM 指数，重点关注最危及生命的情况。 从 1998 年到 2011 年，SMM 的患病率翻了一番，目前影响超过 65,000 人 每年，美国妇女的孕产妇健康对于妇女照顾孩子和生育的能力至关重要。 她一生的健康状况，但我们对 SMM 原因的了解有限。 SMM 研究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 中的种族/民族差异及其影响因素是众所周知的——风险 非西班牙裔黑人中的 SMM 趋势高达 2 倍，西班牙裔和西班牙裔中则高达 1.5 倍 亚洲人相对于非西班牙裔白人 对于这些差异的解释尚不清楚，但只是初步的。 有证据表明，在美国，25% 的女性可能是母亲体重和社会地位不利造成的。 受孕时肥胖，一半在怀孕期间体重增加过多，25% 产后体重保持在 10 磅以上，但是 这因种族而异，一些研究表明肥胖与 SMM 存在关联，但很少有研究表明这一点。 检查肥胖的严重程度、体重不足状况或体重变化的情况要多得多。 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 已经检查了其对 SMM 的贡献。异常高和低的母亲体重以及体重增加是最重要的。 可能存在于社会弱势女性中，但尚未研究其对 SMM 的相互关联的影响。 我们的目标是增进对 SMM 及其种族/民族的生物和社会决定因素的了解 通过分析 2007 年至 2014 年加利福尼亚州的 400 万新生儿，数据包括重要数据。 从怀孕到产后的记录和母婴出院数据。 包括导致 SMM 的最常见病症 – 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 开发的 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 患有 SMM 的妊娠以及它们是否因种族/民族而改变；2) 检查多层次的关联； （个人、家庭、邻里）总体上和按种族/民族划分的 SMM 社会劣势指标 （目标 2a），以及这些关系受母亲体重状况影响的程度（目标 2b）和 3）； 调查孕产妇体重状况和社会劣势对人口负担的影响 SMM 及其种族/民族差异。拟议的研究将通过研究复杂的情况开辟新天地。 母亲体重、社会劣势、种族/民族差异和 SMM 之间的关系。 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。