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）。早产的潜在机制将通过在22-24周（围生存期）的非裔美国人（AA）妇女中建立PTB的预后模型，并在墨西哥裔美国人（MA）妇女中验证该模型来解释。此外，在AA妇女，谁是最危险的早期PTB（<32周妊娠），机制早产和PTB将被解释。由于只有40- 50%的早产以PTB结束，因此了解早产与PTB的区别因素对于改善早产护理和预防早产至关重要。为了实现本研究的具体目标，我们将：具体目标1：在无并发症妊娠的AA妇女中，检查妊娠22-24周时压力的预测能力（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），以区分那些将早产的AA妇女和那些将足月分娩的AA妇女，通过建立一个预测模型。1a.在外部MA妇女人群中建立AA妇女早产的预后模型。具体目标二：在经历早期早产的AA女性中（孕22-32周）检查压力的预测能力（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、BMI、营养摄入）通过建立预后模型来区分那些将早产的AA与那些将足月分娩的AA。具体目标3：检查包括压力在内的可变因素的时间和贡献（知觉压力与CRH）、忧郁、因应行为、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，体重指数和营养摄入）之间的早产发作三组AA妇女的分娩结局（或未发生早产的妇女妊娠22-24周）（1）早产和分娩，2）早产但足月分娩，3）仅经历足月分娩和分娩）。从这项研究中获得的信息将提供有关心理，行为和生理因素的知识，这些因素是早产和早产的基础，对于制定有效的护理干预措施以改善少数民族妇女的分娩结局是必要的。.为了减少少数民族妇女的早产，在怀孕早期（22-24周）确定预测早产的因素很重要。通过与墨西哥裔美国妇女早产预测因素的比较，阐明非洲裔美国妇女早产预测因素。关于少数民族妇女最有可能早产，但在任期内交付和那些最有可能经历早产和分娩的信息将获得在非洲裔美国妇女，谁是最有风险的早期早产，以便有针对性的干预措施，可以设计，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.