Mechanisms Underlying Preterm Birth in Minority Women

描述（由申请人提供）：本申请的总体目标是减少少数民族妇女的早产（PTB）。通过建立非洲裔美国人（AA）妇女22-24周（围生期）PTB的预后模型，并在墨西哥裔美国人（MA）妇女中验证该模型，将阐明早产的机制。此外，对于早期PTB（<32周妊娠）风险最高的AA妇女，将阐明早产和PTB的潜在机制。由于只有40- 50%的早产以产结核结束，了解区分早产和产结核的因素对于改善早产护理和预防早产至关重要。为达到本研究的具体目标，我们将：在无并发症妊娠的AA妇女中，通过建立预后模型，检查妊娠22-24周时压力（感知压力、种族主义、CRH）、抑郁、应对行为、免疫功能（阴道细胞因子）、健康行为（BMI和吸烟）和感染（包括衣原体、淋病和细菌性阴道病）的预测能力，以区分早产和足月分娩的AA妇女。1一个。在MA妇女的外部人群中验证AA妇女早产的预后模型。具体目标2：在经历早期早产（妊娠22-32周）的AA妇女中，通过建立预后模型，检查压力（感知压力，种族主义，CRH），抑郁，应对行为，免疫功能（阴道和宫颈细胞因子），感染（包括衣原体，淋病和细菌性阴道病）和健康行为（吸烟，体重指数，营养摄入）的预测能力，以区分将会早产的AA妇女和将会分娩的AA妇女。具体目标3：检查三组AA妇女（未经历早产的妇女，妊娠22-24周）发生早产（或未经历早产的妇女）之间的可变因素，包括压力（感知压力和CRH）、抑郁、应对行为、免疫功能（阴道和宫颈细胞因子）、感染（包括衣原体、淋病和细菌性阴道病）和健康行为（吸烟、BMI和营养摄入）的时间和贡献：1)分娩和早产，2)早产但足月分娩，3)只经历足月分娩和分娩。从本研究中获得的信息将提供关于早产和早产背后的社会心理、行为和生理因素的知识，并有必要制定有效的护理干预措施，以改善少数民族妇女的分娩结果。确定预测妊娠早期（22-24周）早产的因素对于减少少数民族妇女的早产非常重要。预测非裔美国妇女早产的因素将通过与预测墨西哥裔美国妇女早产的因素进行比较来阐明。少数民族妇女最容易早产但足月分娩的信息，以及最容易经历早产和分娩的信息，将在非洲裔美国妇女中获得，这是早期早产风险最大的群体，因此可以设计有针对性的干预措施，以改善早产的护理和预防早产。

DESCRIPTION (provided by applicant): The overall objective of this application is to decrease preterm birth (PTB) in minority women. Mechanisms underlying preterm birth will be explicated by developing a prognostic model of PTB in African American (AA) women at 22-24 weeks, a period of periviability, and validating the model in Mexican American (MA) women. Additionally, in AA women, who are most at risk for early PTB (<32 weeks gestation), mechanisms underlying preterm labor and PTB will be explicated. As only 40-50 percent of preterm labor ends in PTB, understanding factors that differentiate preterm labor from PTB is vital in improving care of preterm labor and in preventing preterm birth. To meet the specific aims of this study we will: Specific Aim 1: In AA women experiencing uncomplicated pregnancies examine the predictive ability at 22-24 weeks gestation of stress (perceived stress, racism, CRH), depression, coping behaviors, immune function (vaginal cytokines), health behaviors (BMI and smoking), and infection (including Chlamydia, gonorrhea, and bacterial vaginosis), in differentiating those AA women who will deliver preterm, from those who will deliver at term, by building a prognostic model. 1a. Validate the prognostic model for preterm delivery that was developed in AA women in an external population of MA women. Specific Aim 2: In AA women experiencing early preterm labor (between 22-32 weeks gestation) examine the predictive ability of stress (perceived stress, racism, CRH), depression, coping behaviors, immune function (vaginal and cervical cytokines), infection (including Chlamydia, gonorrhea and bacterial vaginosis), and health behaviors (smoking, BMI, nutritional intake) in differentiating those AA who will deliver preterm from those who will deliver at term by building a prognostic model. Specific Aim 3: Examine the timing and contribution of mutable factors including stress (perceived stress and CRH), depression, coping behaviors, immune function (vaginal and cervical cytokines), infection ( including Chlamydia, gonorrhea and bacterial vaginosis), and health behaviors (smoking, BMI and nutritional intake) between the onset of preterm labor (or 22-24 weeks of gestation for women who do not experience preterm labor) to delivery outcome in three groups of AA women (those who: 1) labor and deliver prematurely, 2) labor prematurely but deliver at term and 3) experience only term labor and delivery). The information obtained from this study will provide knowledge about psychosocial, behavioral and physiologic factors that underlie preterm labor and preterm birth and is necessary to develop effective nursing interventions to improve birth outcomes in minority women. . PUBLIC HEALTH RELEVANCE Identifying factors that predict preterm birth early (22-24 weeks) in pregnancy is important in order to decrease preterm birth in minority women. Factors predicting preterm birth in African American women will be explicated by comparing them with factors predicting preterm birth in Mexican American women. Information about minority women most likely to labor prematurely but deliver at term and those most likely to experience preterm labor and delivery will be obtained in African American women, who are most at risk for early preterm birth, so that targeted interventions can be designed to improve the care of preterm labor and prevent preterm birth.