Biobehavioral Determinants of the Microbiome and Preterm Birth in Black Women

描述(申请人提供)：这项研究的目标是阐明在怀孕期间控制非裔美国人(AA)妇女微生物组结构和动态的生物行为决定因素，并调查微生物组组成是否与肺结核有关。这项拟议的研究将有助于从生物、心理和社会角度理解肺结核的种族内风险，为与患有肺结核的AA女性相关的重要风险和保护因素提供洞察，与任何其他美国人口相比，AA女性患肺结核的比例更高。我们的研究与消除种族差异的框架是一致的，该框架认识到研究种族内部潜在风险因素作为至关重要的第一步的重要性，并与国家护理研究所的目标一致，即在各种临床环境和不同人群中促进和改善个人、家庭和社区在整个寿命内的健康。这项研究将前瞻性地招募不同社会经济背景的H960名AA怀孕妇女，并跟踪她们整个分娩过程，在三个时间点收集数据：两次是通过产前护理预约期间的直接参与者接触(怀孕10-14周和26-30周)，一次是通过审查分娩住院的医疗记录。我们将采用嵌套病例对照方法，将所有患有肺结核的妇女(估计为125例)指定为病例；将从分娩足月婴儿的妇女中选择同等数量的对照。利用这项研究设计，我们将：(1)确定怀孕早期和后期阴道、口腔和肠道微生物群的特征；(2)检查与肺结核有关的生物行为因素--包括生物指标和压力体验、营养状况和健康行为--是否影响微生物群的组成；(3)确定怀孕早期和/或晚期阴道、口腔和肠道微生物群的组成是否与肺结核有关；以及(4)调查症状模式是否与增加AA妇女肺结核风险的微生物环境有关。这项研究的成功有几个因素支持。首先，我们召集了临床医生、基础科学家和翻译科学家的多学科合作，他们代表了传染病、妇产科、营养学、遗传学和表观遗传学、应激等领域的专业知识。 在护士科学家的领导下进行生理学、流行病学和信息学研究。其次，我们得到了亚特兰大临床和翻译科学研究所(CTSA奖#NIH UL1TR000454)、埃默里护士科学家跨学科培训奖(T32 NR012715)、埃默里生殖和围产期流行病学奖学金奖以及埃默里综合基因组学核心实验室的支持。第三，亚特兰大是拥有广泛SES的AA女性的家园，其中许多人由Emory的附属分娩医院提供服务，使我们能够对不同的AA女性群体进行采样，允许在研究中的生物行为决定因素有足够的差异，以区分它们对微生物组的独立和交互影响，并最终对肺结核风险产生影响。

DESCRIPTION (provided by applicant): The goals of this study are to elucidate the bio behavioral determinants that govern the structure and dynamics of the microbiome of African American (AA) women during pregnancy and to investigate whether microbiome composition is associated with PTB. The proposed study will contribute to a bio psychosocial understanding of within-race risk for PTB, providing insight into important risk and protective factors relevant to AA women who disproportionately experience PTB compared to any other US population. Our research is consistent with frameworks for eliminating racial disparities, which recognize the importance of studying potential risk factors within-race as a vital first step, and is congruent with the National Institute of Nursing Research goal of promoting and improving the health of individuals, families, and communities across the lifespan in a variety of clinical settings and within diverse populations. The study will prospectively enroll a socioeconomically diverse cohort of H 960 pregnant AA women and follow them through delivery, collecting data at three time points: twice via direct participant contact during prenatal care appointments (at 10-14 and 26-30 weeks' gestation), and once via review of the medical records from the delivery hospitalization. Using a nested case-control approach, we will designate as cases all women who experience PTB (an estimated 125 cases); an equal number of controls will be selected from among those who deliver a term infant. Using this study design we will: (1) Characterize the vaginal, oral, and gut microbiome during early and later pregnancy; (2) Examine whether bio behavioral factors linked with PTB - including biological indicators and experiences of stress, nutritional status, and health behaviors - influence the composition of the microbiome; (3) Determine whether the composition of the vaginal, oral, and gut microbiome in early and/or later pregnancy is associated with PTB; and (4) Investigate whether symptom patterns are associated with microbiomic milieu that increase the risk of PTB among AA women. The success of this research is supported by several factors. First, we have assembled a multidisciplinary collaboration of clinicians and basic and translational scientists representing expertise in infectious disease, obstetrics-gynecology, nutrition, genetics and epigenetics, stress physiology, epidemiology and informatics under the leadership of a nurse-scientist. Second, we have the support of the Atlanta Clinical and Translational Science Institute (CTSA award # NIH UL1TR000454); Emory's Interdisciplinary Training for Nurse Scientists Award (T32 NR012715), Emory's Reproductive and Perinatal Epidemiology Fellowship Award, and the Emory Integrated Genomics Core Laboratory. Third, Atlanta is home to AA women of broad SES, many of whom are served by Emory's affiliated delivery hospitals, enabling us to sample a diverse group of AA women, allowing for sufficient variation in the bio behavioral determinants under study to distinguish their independent and interactive effects on the microbiome and, ultimately, on the risk of PTB.