A Cohort Study of Preterm Delivery in Relation to Partner Abuse, Mood and Anxiety

项目概述/摘要（描述）早产（PTD）仍然是公共卫生和围产期最重要的未解决问题之一。越来越多的证据表明，PTD是一组复杂的问题，具有一系列重叠的因素和影响。正如医学研究所（IOM）最近总结的那样，PTD的病因包括个人层面的行为和心理因素、环境暴露、医疗条件、生物因素和遗传因素，其中许多是综合发生的。IOM专家组成员还指出，以往研究中存在的方法学局限性，包括将PTD视为单一实体，未能识别可能导致PTD的重要常见病理生理途径（例如，系统性炎症、内皮功能障碍、氧化应激和胎盘缺血），阻碍了潜在治疗和预防策略的发现。以前的研究没有严格评估PTD在高危人群中高度相关的社会和神经心理风险因素的独立和联合影响。要从生物学、临床和公共卫生的角度理解PTD，显然需要加强跨学科研究方法的整合。这项研究的总体目标是提供急需的基本信息，了解与妇女心理健康状况和怀孕前和怀孕期间遭受暴力有关的产后抑郁症风险。我们将发展一个由6 000名秘鲁妇女组成的前瞻性队列。我们将研究母亲的儿童期性虐待史、终生和妊娠期ipv与情绪和焦虑障碍（如重度抑郁症、轻度抑郁症、广泛性焦虑和创伤后应激障碍[PTSD]）患病率的关系。我们还将研究PTD风险与妊娠早期情绪障碍和焦虑障碍的关系。我们将评估产妇神经内分泌、血管和免疫状态等多种生物标志物变化对PTD风险的影响程度。最后，我们将研究母亲心理健康和生理状况在IPV和PTD之间的中介作用。

DESCRIPTION (provided by investigator): Project Summary/Abstract (Description) Preterm delivery (PTD) continues to be one of the most significant unsolved problems of public health and perinatology. There is increasing evidence that PTD is a complex cluster of problems with a set of overlapping factors and influences. As recently summarized by the Institute of Medicine (IOM) the causes of PTD include individual-level behavioral and psychological factors, environmental exposures, medical conditions, biological factors, and genetics, many of which occur in combination. Members of the IOM expert panel also noted that persistent methodological limitations in previous studies, including treating PTD as a single entity and failure to recognize important common pathophysiological pathways that may lead to PTD (e.g., systematic inflammation, endothelial dysfunction, oxidative stress, and placental ischemia) have hindered discovery of potential treatment and prevention strategies. Previous studies have not rigorously evaluated the independent and joint effects of potent highly relevant social and neuropsychological risk factors of PTD in high risk populations. Increased efforts that integrate interdisciplinary research approaches are clearly needed to understand PTD from biological, clinical, and public health perspectives. The overarching objective of this study is to provide much-needed fundamental information concerning risk of PTD in relation to women's mental health status and exposure to violence before and during pregnancy. We will develop a prospective cohort of 6,000 Peruvian women. We will study the relation of maternal history of childhood sexual abuse, lifetime- and pregnancy-IPV with the prevalence of mood and anxiety disorders (e.g., major depression, minor depression, generalized anxiety and post-traumatic stress disorder [PTSD]). We will also study associations of PTD risk with mood disorder and anxiety disorder early in pregnancy. We will evaluate the extent to which risk of PTD is influenced by alternations in multiple biological markers of maternal neuroendocrine, vascular, and immune status. Finally, we will study the mediational effect of maternal mental health and physiological status in the relation between IPV and PTD. PUBLIC HEALTH RELEVANCE: Public Health Relevance Statement (Project Narrative-revised) Preterm delivery (PTD) continues to be one of the most significant unsolved problems of public health and perinatology. There is increasing evidence that PTD is a complex cluster of problems with a set of overlapping factors and influences. Violence against women is a more serious and widespread problem than previously recognized. Results from studies conducted in some countries indicate that 10-52 percent of women report physical abuse by an intimate partner at some point in their lives, and that 10-27 percent of women report experiences of sexual abuse. Mood and anxiety disorders, like intimate partner violence (IPV), are prevalent among reproductive age women, and are risk factors of preterm delivery (PTD) an important determinant of infant mortality. We submit that our research is significant and can make a difference insofar as helping to: (1) identify those at greatest risk (i.e. Among women exposed to IPV, who is at risk for adverse outcomes?) and (2) identify specific targets for intervention (i.e. Should interventions be directed at management of mood or anxiety symptoms in pregnancy? At mitigating neuroendocrine consequences of PTSD? Or at providing anti-inflammatory therapy?). Exposure to IPV is an important risk factor for PTD. However, that knowledge alone has limited practical value because eliminating IPV is probably not a feasible goal for healthcare systems. Our overarching goal, therefore, is to generate new knowledge that can be used to design and implement interventions based in the healthcare system; and to understand pathways from IPV to PTD. These goals are in accordance with those articulated by the Institute of Medicine90 and the recent US Surgeon's General's Conference on the Prevention of Preterm Birth233; and are underscored by the U.S. Congress' passing of the Prematurity Research Expansion and Education for Mothers who Deliver Infants Early (PREEMIE) Act (P.L. 109-450)234.