Preterm Birth: Psychoneuroimmunology in Hispanics

描述：(申请人提供)与新生儿早产有关的低出生体重(LBW)是美国婴儿死亡的主要原因。它的发病率在过去20年里没有下降，但因种族而异。压力、焦虑和抑郁是早产种族差异的潜在主要因素。拉美裔美国人是美国增长最快的族群之一，他们的早产率与在美逗留时间的长短有关。与此同时，很少有关于拉美裔早产儿和LBW问题的生物学成分的研究。这项建议的总体目的是测试由压力、宫颈变化和抑郁启动的因果路径的生物行为模型，这些路径可能会改变内分泌和免疫因素，导致炎症反应、宫颈变化，最终导致拉美裔人的LBW和早产。其具体目的是：1)确定压力、焦虑和抑郁对拉美裔孕妇内分泌和免疫因素的影响，这些因素可能导致炎症反应和宫颈变化，从而导致出生时胎龄和出生体重的变化；2)评估压力、焦虑和抑郁对拉美裔孕妇健康行为的影响，这些影响可能会影响出生时胎龄和出生体重的内分泌和免疫因素；以及3)确定人口因素、社会/文化因素和先前早产对拉美裔孕妇压力、焦虑和抑郁的影响。在这项前瞻性研究中，孕妇(最少508人)将从两个地点招募。将采集血液样本，以评估激素、细胞因子和新喋呤的水平。还将获得用于评估细胞因子、新喋呤、胎儿纤维连接蛋白和细菌性阴道病水平的阴道样本。将完成评估压力、焦虑和抑郁的心理问卷。宫颈长度将通过阴道超声进行评估。对新生儿结局数据的医疗记录审查以及对胎龄和出生体重的评估将在超过35周的婴儿分娩后完成。数据分析将包括结构方程建模、多元线性和Logistic回归分析以及相关系数分析。迫切需要更好地了解族裔差异的决定因素以及涉及早产的途径。这项研究采用了一种动态的生物行为方法，在理解拉美裔妇女早产的问题上大有可为。更清楚地了解导致早产的途径和相关的低出生体重之间的相互关系，对于确定和制定适当的预防战略至关重要。

DESCRIPTION: (provided by applicant) Low birth weight (LBW) related to preterm birth of newborns is the leading cause of infant mortality in the United States. Its incidence, which has not decreased in the last twenty years, varies by ethnicity. Stress, anxiety, and depression are potential major factors in ethnic differences in preterm birth. Hispanics are one of the fastest growing ethnic groups in the US, having a pronounced increase in the preterm birth rate associated with length of stay in the US. At the same time there is a paucity of studies with biological components that examine the problem of prematurity and LBW in Hispanics. The overall purpose of this proposal is to test a biobehavioral model of causal pathways initiated by stress, cervical changes, and depression that may alter endocrine and immune factors leading to an inflammatory response, cervical changes, and ultimately LBW and preterm birth in Hispanics. The specific aims are to 1) determine the effects of stress, anxiety, and depression on endocrine and immune factors in Hispanic pregnant women that may lead to an inflammatory response and cervical changes resulting in alterations in gestational age at birth and birth weight, 2) assess the effects of stress, anxiety, and depression on health behaviors in pregnant Hispanic women that may impact endocrine and immune factors resulting in alterations in gestational age at birth and birth weight, and 3) ascertain the effects of demographic factors, social/cultural factors, and previous preterm birth on stress, anxiety, and depression in pregnant Hispanic women. In this prospective study pregnant women (n=508 minimum) will be recruited from two sites. Blood samples for assessment of levels of hormones, cytokines, and neopterin will be taken. Vaginal samples for assessment of levels of cytokines, neopterin, fetal fibronectin and bacterial vaginosis will also be obtained. Psychological questionnaires assessing stress, anxiety, and depression will be completed. Cervical length will be assessed by vaginal ultrasound. Medical record review for neonatal outcome data and an assessment of gestational age and birth weight will be completed after delivery on infants greater than 35 weeks. Data analysis will include structural equation modeling, multiple linear and logistic regression analysis, and correlation coefficient analysis. There is an urgent need to better understand the determinants of ethnic disparities as well as pathways involved in preterm birth. This study adopts a dynamic, biobehavioral approach that holds great promise in understanding the problem of preterm birth in Hispanic women. A clearer understanding of the interrelationships of the pathways leading to preterm birth and associated LBW is essential to determine and develop appropriate preventive strategies.