Chronic stress in pregnancy: Self-report, biomarkers, and birth outcomes

描述(申请人提供)：慢性应激对免疫系统和炎症反应有不利影响，可能是早产的重要原因，并可能导致出生结果中的种族差异。然而，在文献中，母亲压力和早产之间的联系并不一致。一个原因可能是使用了多种不同的调查、工具和工具来衡量怀孕期间的自我报告压力。使用项目反应理论(IRT)建模，我们建议开发一个单一的、全面的、经过验证的量表来测量怀孕期间的自我报告压力--或“优化的”怀孕压力量表。该量表将根据2,006名女性对怀孕、感染和营养(PIN)研究数据库中多次自我报告的压力调查的反应得出。具体地说，IRT根据每一项在概念连续体上的位置(例如，压力严重程度)以及沿该连续体区分个体的能力来表征每一项。有了这个项目级别的数据，就可以确定最佳项目，以实现最优的规模。在PIN研究中，我们建议评估PIN研究中女性自我报告压力与CRH和皮质醇水平的关系，以及自我报告压力与早产之间的关系。孕期自我报告压力的优化量表对于未来的研究至关重要，以便能够检查自我报告压力、压力的生物标记物和早产之间的因果关系。如果可以证明慢性母亲压力可以预测早产，优化的妊娠压力量表可以作为高危孕妇的筛查工具，并作为评估治疗战略的工具，以减轻怀孕期间的压力，减少早产和早产方面的差异。 公共卫生相关性：拟议研究的目标是通过将项目反应理论建模应用于对怀孕、感染和营养(PIN)研究中已收集的2,006名孕妇的多项压力调查的反应，并调查通过优化的压力量表测量的自我报告压力与PIN研究中女性的压力生物标记物和早产之间的关系，来创建一个更有效和更有效的量表来衡量怀孕期间的自我报告压力。如果可以证明慢性母亲压力可以预测早产，那么优化的妊娠压力量表可以作为高危孕妇的筛查工具，并作为评估治疗战略的工具，以减轻怀孕期间的压力，减少早产和早产方面的差异。

DESCRIPTION (provided by applicant): Chronic stress, with adverse effects on the immune system and on inflammatory response, may be an important cause of preterm birth and associated racial disparities in birth outcomes. However, an association between maternal stress and preterm birth has been inconsistently reported in the literature. One reason may be the use of multiple and varied surveys, tools, and instruments to measure self-reported stress in pregnancy. Using item response theory (IRT) modeling, we propose to develop a single, comprehensive, validated scale to measure self- reported stress in pregnancy - or an "optimized" stress in pregnancy scale. The scale will be derived from the responses of 2,006 women to multiple self-reported stress surveys in the Pregnancy, Infection and Nutrition (PIN) Study database. Specifically, IRT characterizes each item according to its location on the concept's continuum (e.g., stress severity) and its ability to discriminate individuals along this continuum. Having this item-level data permits the identification of the best items for an optimized scale. We propose to evaluate the association between self-reported stress, measured by the optimized stress in pregnancy scale and CRH and cortisol levels and between self-reported and preterm birth in women in the PIN Study. An optimized scale of self-reported stress in pregnancy is essential for future studies to be able to examine causal relationships between self-reported stress, biologic markers of stress, and preterm birth. If chronic maternal stress can be shown to be predictive of preterm birth, an optimized stress in pregnancy scale could serve as a screening tool of high-risk pregnant women and as an evaluation tool of treatment strategies to mitigate stress during pregnancy and to reduce preterm delivery and disparities in preterm birth. PUBLIC HEALTH RELEVANCE: The goal of the proposed research is to create a more efficient and effective scale to measure self-reported stress in pregnancy by applying Item Response Theory modeling to the responses to multiple stress surveys already collected from 2,006 pregnant women in the Pregnancy, Infection and Nutrition (PIN) Study and, then, to investigate associations between self-reported stress, measured by the optimized stress scale, and stress biomarkers and preterm birth for women in the PIN Study. If chronic maternal stress can be shown to be predictive of preterm birth, then an optimized stress in pregnancy scale could serve as a screening tool of high-risk pregnant women and as an evaluation tool of treatment strategies to mitigate stress during pregnancy and to reduce preterm delivery and disparities in preterm birth.