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

描述（由申请人提供）：慢性应激，对免疫系统和炎症反应有不良影响，可能是早产和出生结局相关种族差异的重要原因。然而，产妇的压力和早产之间的关联一直不一致的文献报道。一个原因可能是使用多种多样的调查，工具和仪器来测量怀孕期间自我报告的压力。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，有效的规模来衡量自我报告的压力在怀孕-或“优化”的压力在怀孕规模。该量表将来自2,006名妇女对妊娠、感染和营养（PIN）研究数据库中多次自我报告的压力调查的回答。具体来说，IRT根据每个项目在概念连续体上的位置来表征每个项目（例如，压力严重程度）和它的能力，以区别个人沿着这一连续。有了这个项目级数据，就可以确定最佳项目，以获得最佳规模。我们建议评估自我报告的压力之间的关联，测量的优化压力在怀孕规模和CRH和皮质醇水平和自我报告和早产的妇女在PIN研究。一个优化的规模在怀孕期间的自我报告的压力是必不可少的，未来的研究能够检查自我报告的压力，压力的生物标志物和早产之间的因果关系。如果母亲的慢性压力可以被证明是早产的预测，一个优化的压力在怀孕的规模可以作为一个筛选工具的高风险孕妇，并作为一个评估工具的治疗策略，以减轻压力在怀孕期间，以减少早产和早产的差异。 公共卫生相关性：拟议研究的目标是创建一个更有效和更有效的规模来衡量自我报告的压力在怀孕期间，通过应用项目反应理论建模的反应，多个压力调查已经收集了从2,006名孕妇在怀孕，感染和营养（PIN）研究，然后，调查之间的关联自我报告的压力，测量优化的压力规模，压力生物标志物和早产的关系。如果母亲的慢性压力可以被证明是早产的预测，那么一个优化的压力在怀孕规模可以作为一个筛选工具的高危孕妇和作为一个评估工具的治疗策略，以减轻压力在怀孕期间，以减少早产和早产的差异。

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.