Stress and Health in American Indian Pregnancies

项目总结/摘要 心血管疾病是美洲印第安人死亡的主要原因， 这一人群中与心血管相关的过早死亡率正在恶化。在2000年至2015年期间， 25-49岁的美洲印第安人的心血管疾病死亡率增加了 2.1%，但在美国其他种族/族裔群体中年龄相仿的个体中下降或趋于稳定。 美国心脏协会最近呼吁对慢性心脏病的后果进行代际检查。 压力，如童年逆境和创伤，对婴儿和儿童心血管危险因素的影响。 美洲印第安人因暴力、强迫搬迁和 强迫文化适应。此外，美洲印第安人群体暴露于更高水平的不良反应， 童年经历（ACE）比美国其他种族/族裔群体。婴儿的成长是一个 公认的成年期心血管疾病的危险因素，但母亲不良反应之间的关系， 美国印第安人的童年经历和婴儿成长是未经审查的。调查 慢性应激对孕产妇下丘脑-垂体-肾上腺轴功能及产科的影响 结果是重要的，因为这些机制可能在于慢性压力和婴儿之间的途径， 增长美国印第安人怀孕中的压力和健康（SHAIP）研究与美国印第安人协会的目标一致。 土著创伤和复原力研究中心与美国印第安人社区合作， 文化相关的研究。SHAIP研究将招募来自3个部落的375名怀孕的美国印第安妇女。 北达科他州的社区，在怀孕期间收集详细的生物，医学和社会数据1次， 分娩、产后6个月和产后12个月。在目标1中，我们将评估 母亲ACE和母亲头发皮质醇浓度在怀孕期间。在目标2中，我们将检验假设 母体头发皮质醇浓度介导母体ACE与母体和 产科结果。最后，在目标3中，我们将研究产妇之间关系的多种介质 ACE与婴儿生长这项研究计划将使我能够第一次研究 母亲ACE和婴儿生长之间的途径。潜在的可改变的介质，如母乳喂养， 孕产妇健康可以为针对北美印第安人的文化干预提供信息。 达科他州实现这个项目的具体目标将使我成为一个领先的学者， 母亲ACE和婴儿心脏代谢危险因素的代际传递。

Project Summary/Abstract Cardiovascular disease is the leading cause of mortality among American Indian populations, and cardiovascular-related premature mortality among this population is worsening. Between 2000 and 2015, cardiovascular disease mortality rates among American Indian individuals aged 25-49 years increased by up to 2.1%, yet declined or plateaued among similarly aged individuals in other racial/ethnic groups in the U.S. The American Heart Association recently called for intergenerational examinations of consequences of chronic stress, such as childhood adversity and trauma, on cardiovascular risk factors among infants and children. American Indian populations have been exposed to historic trauma through violence, forced relocation and forced acculturation. Additionally, American Indian populations are exposed to higher levels of Adverse Childhood Experiences (ACEs) than other racial/ethnic groups in the United States. Infant growth is a recognized risk factor for cardiovascular disease in adulthood, yet the relationship between maternal adverse childhood experiences and infant growth among American Indian populations is unexamined. Investigation of the effect of chronic stress on maternal hypothalamic-pituitary-adrenal axis function and maternal and obstetric outcomes is important, as these mechanisms may lie on the pathway between chronic stress and infant growth. The Stress and Health in American Indian Pregnancies (SHAIP) study aligns with the goals of the Indigenous Trauma and Resiliency Research Center by partnering with American Indian communities in culturally relevant research. The SHAIP study will enroll 375 pregnant American Indian women from 3 tribal communities in North Dakota, collecting detailed biologic, medical, and social data 1 time during pregnancy, at birth, at 6 months postpartum and at 12 months postpartum. In Aim 1, we will assess the association between maternal ACEs and maternal hair cortisol concentration during pregnancy. In Aim 2, we will test the hypothesis that maternal hair cortisol concentration mediates the association between maternal ACEs and maternal and obstetric outcomes. Lastly, in Aim 3, we will examine multiple mediators of the relationship between maternal ACEs and infant growth. This proposed research project will allow me to examine, for the first time, potential pathways between maternal ACEs and infant growth. Potentially modifiable mediators like breastfeeding and maternal health may inform culturally informed interventions targeting American Indian populations in North Dakota. Achieving the Specific Aims of this project will enable me to establish myself as a leading scholar in the intergenerational transmission of maternal ACEs and cardiometabolic risk factors among infants.