Social stressors and inflammation: A mixed methods approach to preterm birth

项目摘要/摘要 黑人妇女的产妇发病率和死亡率是美国最高的。孕产妇死亡率为3-4 黑人女性比白人女性高出一倍(42vs13/10万活产)。而在此期间死亡 怀孕和产后期可能与直接原因有关，如心血管事件、感染、 如果我们要降低产妇死亡率，就必须进一步调查上游的因素。使用 围产期健康的生命历程框架，我们建议将黑人妇女的一生创伤作为一种 孕产妇发病率增加的风险低于孕产妇死亡率的风险。因以下原因造成的终身创伤 暴露于种族主义，生活在无序程度较高的社区(例如，空置的房屋)和犯罪， 而她们一生中的社会经济逆境可能会增加黑人妇女患产妇疾病的风险 包括与妊娠有关的并发症(如先兆子痫)、感染、心血管疾病和 抑郁症状。较短的端粒长度(TL)，一种衡量慢性应激的生物学指标，与种族主义有关， 邻里关系混乱和社会经济逆境；并增加抑郁症状和 心血管疾病。终生创伤也与更大的全身炎症有关[例如，更高水平的 促炎症细胞因子和C-反应蛋白(CRP)]。我们的假设是 创伤(以妇女报告和较短的TL衡量)与产妇发病率的较高风险有关；系统性 炎症调节了这种联系。 这项补充研究的目标是检查终生创伤与母亲 黑人女性的发病率，以及全身炎症的变化是否调节了这种联系。我们的 该队列由来自密歇根州底特律和俄亥俄州哥伦布地区的658名怀孕的黑人妇女组成。女人 完成了关于他们童年时期(参考年龄为10岁)和 怀孕，包括种族主义、邻里混乱和犯罪，以及社会经济逆境。抑郁 还测量了怀孕期间的症状。妇女抽血进行细胞因子和C反应蛋白分析 以及为TL收集的唾液。产科和病史是从母亲的病历中提取的。为 在这项补充研究中，我们将使用孕产妇发病率的全球衡量标准(例如，先兆子痫、感染、 心血管疾病、抑郁症状)。我们将把医疗补助申请数据与我们的医疗记录联系起来 摘要数据，以确保全面说明妇女在怀孕期间的孕产妇发病率 出生后1年内。我们的目标是：(1)研究产妇发病率与终生创伤的关系。 (1a，女性终生创伤报告；1b，tl)；和(2)检查全身炎症的相关性 伴随着终生创伤和产妇发病率。这项研究将为更大规模的研究提供初步数据 研究终生创伤对黑人妇女产妇发病率的影响。

PROJECT SUMMARY/ABSTRACT Black women have the highest rates of maternal morbidity and mortality in the US. Maternal mortality is 3-4 times higher among Black women than White women (42 vs 13/ 100,000 live births). While deaths during pregnancy and the postpartum period can be linked to direct causes, such as cardiovascular events, infections, and hemorrhage, we must investigate factors further upstream if we are to reduce maternal mortality. Using a life course framework for perinatal health, we propose to study Black women’s lifetime trauma as an antecedent to the increased risks of maternal morbidity that underly maternal mortality. Lifetime trauma due to exposures to racism, living in neighborhoods with higher levels of disorder (e.g., vacant houses) and crime, and socioeconomic adversities throughout their lives may increase risk for maternal morbidity for Black women including pregnancy-related complications (e.g., preeclampsia), infections, cardiovascular disease and depressive symptoms. Shorter telomere length (TL), a biological measure of chronic stress, relates to racism, neighborhood disorder, and socioeconomic adversities; and increases the risk for depressive symptoms and cardiovascular. Lifetime trauma has also been related to greater systemic inflammation [e.g., higher levels of pro-inflammatory cytokines and C-Reactive Protein (CRP)] among Blacks. Our hypothesis is that lifetime trauma (measured by women’s reports and shorter TL) relates to higher risk for maternal morbidity; systemic inflammation mediates this association. The goal of this supplemental study is to examine the association of lifetime trauma with maternal morbidity among Black women, and whether alterations in systemic inflammation mediate this association. Our cohort is comprised of 658 pregnant Black women from the Detroit, MI and Columbus, OH areas. Women completed questionnaires about their experiences during childhood (age 10 as reference) and during pregnancy including racism, neighborhood disorder and crime, and socioeconomic adversity. Depressive symptoms during pregnancy were also measured. Women had blood drawn for cytokines and CRP analysis and saliva collected for TL. Obstetrical and medical history were abstracted from maternal medical records. For this supplemental study, we will use a global measure of maternal morbidity (e.g., preeclampsia, infections, cardiovascular conditions, depressive symptoms). We will link Medicaid claims data with our medical records abstraction data to ensure a comprehensive account of maternal morbidity for women during their pregnancy and within 1 year after birth. We aim to: (1) Examine the association of maternal morbidity with lifetime trauma (1a, women’s reports of lifetime trauma; 1b, TL); and (2) Examine the associations of systemic inflammation with lifetime trauma and maternal morbidity. This study will provide preliminary data for a larger study to examine the role of lifetime trauma on maternal morbidity among Black women.