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

早产与伴侣虐待、情绪和焦虑相关的队列研究

• 批准号: 8551398
• 负责人: MICHELLE A. WILLIAMS
• 金额: $ 54.1万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8551398
• 关键词: Age; Anti-Inflammatory Agents; Anti-inflammatory; Anxiety; Anxiety Disorders; Behavioral; Biological; Biological Factors; Biological Markers; Biological Psychiatry; Blood Vessels; C-reactive protein; Child Abuse; Child Sexual Abuse; Clinical; Cohort Studies; Communities; Comorbidity; Complex; Congresses; Corticotropin-Releasing Hormone; Country; Education; Emotional; Environmental Exposure; Epidemiologic Studies; Exposure to; Failure; Family; Functional disorder; Genetic; Goals; Health Status; Healthcare Systems; Immune; Individual; Infant; Infant Mortality; Inflammation; Institute of Medicine (U.S.); Institutes; Interdisciplinary Study; Interleukin-6; Intervention; Investments; Ischemia; Joints; Knowledge; Lead; Low income; Major Depressive Disorder; Maternal Exposure; Mediator of activation protein; Medical; Mental Depression; Mental Health; Metabolic; Mood Disorders; Moods; Mothers; Neurosecretory Systems; Newborn Infant; Outcome; Oxidative Stress; Partner Abuse; Pathway interactions; Perinatal; Perinatology; Personal Satisfaction; Physiological; Population; Post-Traumatic Stress Disorders; Pregnancy; Premature Birth; Prevalence; Prevention; Prevention strategy; Psychological Factors; Public Health; Recording of previous events; Reporting; Research; Research Personnel; Risk; Risk Factors; Role; Sexual abuse; Surgeon; Symptoms; Violence; Woman; abstracting; adverse outcome; base; clinical application; cohort; design; experience; girls; high risk; improved; innovation; intimate partner violence; member; minor depressive disorder; neuropsychological; physical abuse; premature; prospective; public health relevance; reproductive; social; symposium; treatment strategy; violence against women; young woman

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.

描述（由研究者提供）：项目摘要/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的原因包括个人水平的行为和心理因素，环境暴露，医疗条件，生物因素和遗传学，其中许多是组合发生的。IOM专家组成员还指出，以往研究中持续存在的方法学局限性，包括将PTD视为单一实体，以及未能认识到可能导致PTD的重要共同病理生理学途径（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高危人群中强有力的高度相关的社会和神经心理危险因素的独立和联合作用。显然需要加大努力，整合跨学科的研究方法，从生物学，临床和公共卫生的角度来了解PTD。这项研究的总体目标是提供急需的基本信息，有关PTD的风险与妇女的心理健康状况和暴露于暴力之前和怀孕期间。我们将培养一批6 000名秘鲁妇女。我们将研究母亲儿童期性虐待史、终生和妊娠期IPV与情绪和焦虑障碍（例如，重度抑郁症、轻度抑郁症、广泛性焦虑症和创伤后应激障碍[PTSD]）。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PTD风险受母体神经内分泌、血管和免疫状态的多种生物标志物改变影响的程度。最后，我们将研究产妇心理健康和生理状况在IPV与PTD关系中的中介作用。 公共卫生相关性：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。对妇女的暴力行为是一个比以前认识到的更为严重和普遍的问题。在一些国家进行的研究结果表明，10%至52%的妇女报告说，她们在生活中的某个阶段受到亲密伴侣的身体虐待，10%至27%的妇女报告说，她们遭受过性虐待。情绪和焦虑障碍，如亲密伴侣暴力，在育龄妇女中普遍存在，是早产的风险因素，早产是婴儿死亡率的重要决定因素。我们认为，我们的研究意义重大，可以在以下方面发挥作用：（1）确定风险最大的人群（即在暴露于IPV的女性中，谁有不良后果的风险？）和（2）确定具体的干预目标（即干预措施是否应该针对怀孕期间的情绪或焦虑症状的管理？减轻创伤后应激障碍的神经内分泌后果？或者提供抗炎治疗？）。暴露于IPV是PTD的重要危险因素。然而，仅凭这些知识的实用价值有限，因为消除IPV可能不是医疗保健系统的可行目标。因此，我们的总体目标是产生可用于设计和实施基于医疗保健系统的干预措施的新知识;并了解从IPV到PTD的途径。这些目标与医学研究所90和最近的美国外科医生预防早产大会233所阐述的目标一致;美国国会通过的《早产儿研究扩展和早产儿母亲教育（PREEMIE）法案》（P.L. 234.第234节