Physiologic Stress During Pregnancy on Maternal and Infant Outcomes

怀孕期间的生理压力对母婴结局的影响

• 批准号: 8838867
• 负责人: Tiffany A Moore
• 金额: $ 7.51万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-15 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8838867
• 关键词: Academic Medical Centers; Admission activity; Anti-Inflammatory Agents; Anti-inflammatory; Antioxidants; Automobile Driving; Autonomic nervous system; Bachelor' s Degree; Behavior; Behavioral; Bilirubin; Biological; Biological Factors; Biological Markers; Biology; Birth; Blood; Bronchopulmonary Dysplasia; Chronic stress; Clinical; Clinical Research; Collaborations; Data; Databases; Development; Diagnosis; Discipline; Discipline of Nursing; Disease; Doctor of Philosophy; Education; Effectiveness of Interventions; Environment; Foundations; Free Radicals; Funding; Gestational Age; Glutathione; Goals; Group Practice; Health; Health Promotion; Homeostasis; Hospitals; Hour; Hydrocortisone; Hydroxyl Radical; Hyperbilirubinemia; Hypoglycemia; IL8 gene; Immune; Immune system; Incidence; Infant; Infant Health; Inflammation; Inflammatory; Interleukin-10; Interleukin-6; K-Series Research Career Programs; Knowledge; Laboratories; Life; Longevity; Measurement; Measures; Medical center; Mentors; Nebraska; Necrotizing Enterocolitis; Neonatal; Neonatal Intensive Care Units; Neurosecretory Systems; Newborn Infant; Nitric Oxide; Nurses; Outcome; Oxidation-Reduction; Oxidative Stress; Oxygen; Pathology; Patient risk; Physiological; Physiology; Play; Population; Pre-Eclampsia; Pregnancy; Pregnant Women; Premature Birth; Premature Infant; Premature Labor; Premature Rupture Fetal Membranes; Preventive Intervention; Psychology; Race; Recruitment Activity; Research; Resources; Resuscitation; Retinopathy of Prematurity; Risk; Role; Science; Scientist; Sepsis; Severities; Site; Socioeconomic Status; Stress; Superoxide Dismutase; Superoxides; Techniques; Training; Training Programs; Translational Research; Translations; Umbilical Cord Blood; United States National Institutes of Health; Universities; Woman; adverse outcome; allostatic load; base; biobehavior; body system; career; clinical practice; congenital anomaly; cytokine; disorder prevention; evidence base; experience; feeding; fetal medicine; high risk; improved; infant outcome; insight; interest; intervention program; intraamniotic infection; intraventricular hemorrhage; multidisciplinary; neonate; neurobehavioral; perinatal outcomes; prenatal; prenatal influence; programs; research study; respiratory distress syndrome; response; screening; skills; social; social model

DESCRIPTION (provided by applicant): Candidate: My undergraduate degrees in Biology, Psychology, and Nursing and the PhD in Nursing have provided the educational foundation to become a biobehavioral nurse scientist. My experiences in bedside and transport nursing in the newborn intensive care unit (NICU) have provided the clinical foundation for research in the neonatal population. My long-term career goal is to reduce the severity of neonatal complications and ultimately improve the health of infants who are born at risk for long-term, debilitating outcomes and build the foundation of health across the lifespan. My long-term research goals are to: 1) participate in the translation of pathophysiologic mechanisms and biological measures from bench science to clinical research and practice for infants at risk for adverse outcomes; and 2) develop an evidenced-based screening program for use during the prenatal period to allow for the implementation of health promotion and disease prevention interventions in pregnant women to improve outcomes their newborn infants. The objectives for this K01 application provide the critical development of knowledge and skills necessary to achieve these long-term research goals: obtain training on oxidative stress mechanisms and measurement techniques from an expert bench scientist in oxidative stress for translation to clinical neonatal research; obtain training on behavioral, stress, and immunological mechanisms and measurements in pregnant women from a senior nurse scientist in prenatal research; obtain training on behavioral, stress, and immunological mechanisms and measurements in neonates from a senior nurse scientist in neonatal research; and strengthen academic and professional skills to be an independent nurse scientist. Environment: The University of Nebraska Medical Center (UNMC) is an academic medical center with a hospital affiliate on campus that encourages collaboration across disciplines for research and education. UNMC has a strong research program in Redox Biology with several expert scientists and resources available. As an expert bench scientist in Redox Biology at UNMC, Dr. Matthew Zimmerman will serve as primary mentor to enhance my knowledge on the physiology and measurement techniques associated with oxidative stress. I will participate in several educational and laboratory opportunities to acquire the necessary skills to conduct translational research with a multidisciplinary team. Dr. Ann Berger will serve as a Co-mentor and on-site senior nurse scientist and key mentor to coordinate and track progress towards my goals and objectives. My dissertation research provided data to examine prenatal influences on neonatal outcomes. Therefore, Dr. Jeanne Ruiz, an expert nurse scientist in prenatal biobehavioral research, will serve as a co-mentor to provide education and application of prenatal research into my research program. Since my primary research interest is in the neonatal population, Dr. Rita Pickler also will serve as a Co-mentor because of her expertise in neonatal research and neurobehavioral development in preterm infants. Both Dr. Pickler and Dr. Ruiz have large databases from NIH-funded research and will facilitate analyses related to my research. Research: The primary goal of this career development award is to investigate potential relationships between allostatic load (a bio-psycho-social model of the effects of chronic stress on body systems) in high-risk pregnant women, their newborn infants, and perinatal outcomes. Allostatic load (AL) is conceptually and operationally defined as physiologic dysregulation of AL parameters of inflammation and oxidative stress from the immune system. AL parameters will be measured in the blood of high-risk pregnant women collected between 18-21 weeks gestational age and prior to delivery, in the cord blood collected at birth, and in the blood collected between 24-48 hours after birth in the newborn infant and include specific free radicals (e.g. superoxide, hydroxyl radical, nitric oxide), antioxidants (e.g., bilirubin, glutathione, superoxide dismutase), and inflammatory cytokines (e.g., IL-6, IL-8, IL-10) from the immune system. Sixty women seen by the high-risk maternal-fetal-medicine practice group and their newborn infants with no known congenital anomalies will be recruited. The aims of the research study are: 1) investigate associations between AL parameters in high-risk pregnant women with AL parameters in the cord blood and in their newborn infants; 2) determine relationships among AL parameters in high-risk pregnant women with prenatal complications; and 3) examine associations among neonatal outcomes and AL parameters in high-risk pregnant women, AL parameters in the cord blood collected at birth, and AL parameters in their newborn infants. Successful completion of this study will provide new insight into biological factors associated with prenatal and neonatal complications. This study will advance our understanding of the role that oxidative stress and inflammatory mechanisms may be playing in driving these complications in prenatal and neonatal populations. The significance of this study is that it will enhance knowledge to improve outcomes for infants at risk for adverse outcomes. The training program will develop the applicant to become an independent nurse scientist with a focus on biobehavioral research in maternal and neonatal populations and to conduct translational research using multidisciplinary teams.

候选人：我的生物学、心理学和护理学本科学位以及护理学博士学位为成为一名生物行为护理科学家提供了教育基础。我在新生儿重症监护病房（NICU）的床边和转运护理经验为新生儿人群的研究提供了临床基础。我的长期职业目标是降低新生儿并发症的严重程度，并最终改善出生时面临长期衰弱后果风险的婴儿的健康状况，并在整个生命周期中建立健康的基础。我的长期研究目标是：1)参与将有不良后果风险的婴儿的病理生理机制和生物学措施从实验室科学转化为临床研究和实践；2)制定一项基于证据的筛查计划，用于产前期间，允许在孕妇中实施健康促进和疾病预防干预措施，以改善其新生儿的结局。这个K01应用程序的目标提供了实现这些长期研究目标所需的知识和技能的关键发展：从氧化应激专家实验室科学家那里获得氧化应激机制和测量技术的培训，以转化为临床新生儿研究；从产前研究的资深护士科学家那里获得有关孕妇行为、压力和免疫机制和测量的培训；从新生儿研究领域的资深护士科学家那里获得有关新生儿行为、压力和免疫机制和测量的培训；加强学术和专业技能，成为一名独立的护士科学家。环境：内布拉斯加大学医学中心（UNMC）是一个学术医学中心，在校园内有附属医院，鼓励跨学科的研究和教育合作。UNMC在氧化还原生物学方面拥有强大的研究计划，拥有几位专家科学家和可用资源。作为在UNMC氧化还原生物学的专家板凳科学家，马修·齐默尔曼博士将作为主要的导师，以提高我对氧化应激相关的生理和测量技术的知识。我将参加一些教育和实验室的机会，以获得必要的技能，与一个多学科团队进行转化研究。安·伯杰博士将担任联合导师和现场高级护士科学家以及协调和跟踪我的目标和目的进展的关键导师。我的论文研究提供了数据来检查产前对新生儿结局的影响。因此，Jeanne Ruiz博士，一位产前生物行为研究方面的专家护士科学家，将作为我的共同导师，为我的研究项目提供产前研究的教育和应用。由于我的主要研究兴趣是在新生儿人口，丽塔·皮克勒博士也将担任共同导师，因为她在新生儿研究和早产儿神经行为发育方面的专业知识。Pickler博士和Ruiz博士都有来自美国国立卫生研究院资助研究的大型数据库，并将促进与我的研究相关的分析。研究：该职业发展奖的主要目标是研究高危孕妇及其新生儿的适应负荷（慢性应激对身体系统影响的生物-心理-社会模型）与围产期结局之间的潜在关系。适应负荷（AL）在概念上和操作上被定义为免疫系统炎症和氧化应激AL参数的生理失调。将在18-21孕周和分娩前收集的高危孕妇血液、出生时收集的脐带血以及新生儿出生后24-48小时收集的血液中测量AL参数，包括来自免疫系统的特定自由基（如超氧化物、羟基自由基、一氧化氮）、抗氧化剂（如胆红素、谷胱甘肽、超氧化物歧化酶）和炎症细胞因子（如IL-6、IL-8、IL-10）。将招募60名高危母胎医学实践组所见的妇女及其没有已知先天性异常的新生儿。本研究的目的是：1)探讨脐带血AL参数增高的高危孕妇及其新生儿AL参数的相关性；2)确定产前并发症高危孕妇AL参数之间的关系；3)检查新生儿结局与高危孕妇AL参数、出生时采集脐带血AL参数及其新生儿AL参数的关系。这项研究的成功完成将为产前和新生儿并发症相关的生物学因素提供新的见解。这项研究将促进我们对氧化应激和炎症机制可能在产前和新生儿人群中导致这些并发症的作用的理解。本研究的意义在于，它将提高对有不良后果风险的婴儿预后的认识。该培训计划将培养申请人成为一名独立的护士科学家，专注于孕产妇和新生儿群体的生物行为研究，并使用多学科团队进行转化研究。