Unintended Pregnancy in Women with Chronic Medical Conditions

简介（由申请人提供）：庄医生是一名普通内科医生，长期的职业目标是成为一名独立的研究者，研究患有慢性疾病的妇女的生殖健康。拥有普通内科奖学金培训和流行病学硕士学位，她已经为本申请中描述的工作奠定了必要的基础。在拟议拨款期间，她的直接目标是对患有普遍慢性疾病（特别是糖尿病、高血压和肥胖）的妇女进行意外怀孕风险因素的研究。为了实现这一目标，她将与在生殖健康研究、调查研究、人口学、社会心理学和纵向数据分析方面具有专业知识的导师密切合作。她制定了一个由正式课程和其他活动组成的培训计划，这将使她能够发展自己的研究技能，成为该领域的独立调查员。该研究项目的目的是比较1)未来生育意愿，2)避孕药具的使用，以及3)有和没有慢性疾病的妇女意外怀孕的发生率。这些目标将通过2004年行为风险因素监测系统的横断面分析和宾夕法尼亚中部妇女健康研究的纵向分析来实现，这是一项独特的正在进行的孕前健康前瞻性队列研究。这项定量工作将由一项焦点小组研究加以补充，以探讨生育意愿的意义、对不良妊娠结果的风险认知以及慢性疾病妇女使用避孕药具的情况。这项研究将开始确定患有慢性疾病的妇女如何经历有意怀孕和意外怀孕。由于有疾病的妇女患与妊娠有关的疾病和不良妊娠后果的风险增加，因此避免意外怀孕至关重要。候选人提出的工作符合国家儿童健康和人类发展研究所确保健康和想要的怀孕的使命，是在这一高危妇女群体中减少意外怀孕和促进健康怀孕的必要的第一步。

DESCRIPTION (provided by applicant): Dr. Chuang is a General Internist with the long-term career goal of being an independent investigator in the study of reproductive health for women with chronic medical conditions. With General Internal Medicine fellowship training and a Masters of Science in Epidemiology, she has developed the necessary groundwork to pursue the work described in this application. Her immediate goal during the proposed grant period is to conduct research on risk factors of unintended pregnancy in women with prevalent chronic conditions, specifically diabetes, hypertension, and obesity. To achieve this goal, she will work closely with mentors with expertise in reproductive health research, survey research, demography, social psychology, and longitudinal data analysis. She has developed a training program consisting of formal coursework and other activities that will allow her to develop her research skills to become an independent investigator in this area. The aims of the research project are to compare 1) the future childbearing intentions, 2) contraceptive use, and 3) unintended pregnancy occurrence in women with and without chronic medical conditions. These aims will be achieved through cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance System and longitudinal analysis of the Central Pennsylvania Women's Health Study, a unique ongoing prospective cohort study of pre-conceptional health. This quantitative work will be complemented by a focus group study to explore the meaning of childbearing intentions, risk perception of adverse pregnancy outcomes, and contraceptive use in women with chronic medical conditions. This research will begin to define how women with chronic medical conditions experience intended and unintended pregnancy. Since women with medical conditions are at increased risk for pregnancy-related morbidity and adverse pregnancy outcomes, avoidance of unintended pregnancy is critically important. The work proposed by the candidate is congruent with the National Institute of Child Health and Human Development mission to ensure healthy and wanted pregnancies, and is a necessary first step toward reducing unintended pregnancies and promoting healthy pregnancy in this high-risk group of women.