Psychosocial Intervention, Maternal Inflammation, and Birth Outcomes: Centering vs. Routine Prenatal Care (PIINC) Study

1美国的早产率大大高于其他工业化国家， 2而且在低收入和少数族裔女性中比例更高。这些差异已经证明 3尽管努力很大，但仍难以改善。然而，最近的研究表明，基于群体的模型 4.产前检查(GPNC)--以怀孕为中心--可显著减少低收入少数民族妇女的肺结核。 孕期是一种多方面的集体干预，它综合了产前保健的三个方面：健康 6评估、教育和社会支持。然而，人们对GPNC的机制知之甚少 7可以减少肺结核，因为导致肺结核的生物途径仍然不完全清楚。一口井- 8支持的理论认为母体循环和母胎界面存在过度炎症活动 9作为肺结核的病原学。我们小组和其他人将不利的社会经济状况和产妇 10个具有循环炎症生物标志物、慢性胎盘炎和不良反应的心理社会功能 11例妊娠结局。GPNC可通过减少全身和胎盘炎性活动来减少肺结核 12改善处于社会不利地位的妇女的心理社会功能。在一项初步研究中，我们 13发现证据表明，GPNC改善了胎盘炎性病变的社会经济差异 14和基因表达谱。尽管这些结果很有希望，但需要在更大的队列中复制 15以确定GPNC影响的心理、行为和生物机制 16母胎交界处的炎症活动，利用胎盘基因表达来评估替代 17条生物途径，并澄清这些变化对减少结核病差异的影响。 18在这里，我们建议通过利用南卡罗来纳州格林维尔的现有试验来解决这些问题 19(1R01HD082311)，将从以低收入为主的人口中招收3160名妇女。家长研究 20采用随机对照试验设计将GPNC与传统产前护理进行比较，并 21有足够的能力通过干预和种族来检测肺结核的差异。家长研究将收集和 22分析行为和心理社会结果的调查措施，但它没有资源来 23收集生物标记物或评估生物作用机制。这项提案的目标是添加生物素 24收集到现有的试验，以了解GPNC是否通过改善心理社会和行为 25的功能，影响妊娠期间的炎症环境。样本将从1150名妇女中收集 26和对900个随机子集进行的全面分析，目的是(1)量化系统性差异 27个炎症生物标记物、胎盘组织学炎症和胎盘基因表达 28参加GPNC和接受常规产前护理的人和(2)确定这些差异是否 29受心理社会功能和/或生活方式特征改善的影响。最终，我们的目标是 30了解GPNC降低肺结核发病率的生物学机制。

1 Preterm birth (PTB) rates are substantially higher in the United States than in other industrialized nations, 2 and are disproportionately greater among-low income and minority women. These disparities have proven 3 difficult to ameliorate despite intensive efforts. However, recent studies indicate that a group-based model of 4 prenatal care (GPNC), CenteringPregnancy, significantly reduces PTB in low-income, minority women. 5 CenteringPregnancy is a multifaceted group intervention that integrates three aspects of prenatal care: health 6 assessment, education, and social support. However, little is known about the mechanisms by which GPNC 7 reduces PTB, since the biologic pathways leading to PTB are still incompletely understood. One well- 8 supported theory posits excessive inflammatory activity in maternal circulation and the maternal-fetal interface 9 as an etiology for PTB. Our group and others have linked adverse socioeconomic conditions and maternal 10 psychosocial functioning with circulating inflammatory biomarkers, chronic placental inflammation, and adverse 11 pregnancy outcomes. GPNC may reduce PTB by reducing systemic and placental inflammatory activity 12 through improved psychosocial functioning of women in socially disadvantaged conditions. In a pilot study, we 13 found evidence suggesting that GPNC ameliorates socioeconomic differences in placenta inflammatory lesions 14 and gene expression profiles.Though promising, replication of these results in a larger cohort is needed in 15 order to identify psychological, behavioral and biological mechanisms through which GPNC affects 16 inflammatory activity at the maternal-fetal interface,utilize placental gene expression to evaluate alternate 17 biologic pathways and to clarify the implications of these changes for reduction of PTB disparities. 18 Here, we propose to address these questions by leveraging an existing trial in Greenville, South Carolina 19 (1R01HD082311) that will enroll 3160 women from a predominantly low-income population. The parent study 20 employs a randomized controlled trial design to compare GPNC with traditional prenatal care, and is 21 adequately powered to detect differences in PTB by intervention and race. The parent study will collect and 22 analyze survey measures of behavioral and psychosocial outcomes, but it does not have the resources to 23 collect biomarkers or evaluate biologic mechanisms of action. The goal of this proposal is to add biospecimen 24 collection to the existing trial in order to understand whether GPNC, by improving psychosocial and behavioral 25 functioning, influences the inflammatory milieu during gestation. Specimens will be collected from 1150 women 26 and full analysis performed on a random subset of 900, with the aims of (1) quantifying differences in systemic 27 inflammatory biomarkers, placental histologic inflammation, and placental gene expression between women 28 participating in GPNC and those receivng routine prenatal care and (2) determining whether these differences 29 are mediated by improvements in psychosocial functioning and/or lifestyle characteristics. Ultimately, we aim to 30 understand the biological mechanisms through which GPNC reduces the frequency of PTB.