The effect of hypertensive disorders in pregnancy and HIV-infection on maternal, birth and infant outcomes in South Africa

南非妊娠期高血压疾病和艾滋病毒感染对孕产妇、分娩和婴儿结局的影响

• 批准号: 9919020
• 负责人: Amy Louise Slogrove
• 金额: $ 11.33万
• 依托单位: STELLENBOSCH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-22 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9919020
• 关键词: 37 weeks gestation; Anti-Retroviral Agents; Area; Automobile Driving; Award; Biometry; Birth; CD4 Lymphocyte Count; Child; Childhood; Clinical Research; Complement; Consequences of HIV; Country; Data Collection; Data Sources; Development Plans; Disease; Eclampsia; Environment; Epidemiology; Female of child bearing age; Funding; General Population; Goals; HIV; HIV Infections; HIV therapy; HIV-exposed uninfected infant; Health; Hospitalization; Individual; Infant; Infant Mortality; Infectious Pregnancy Complications; Institution; Leadership; Low Birth Weight Infant; Maternal Health; Maternal Mortality; Maternal and Child Health; Mediating; Mediation; Mentors; Mentorship; Morbidity - disease rate; Mothers; National Institute of Child Health and Human Development; Neonatal Mortality; Newborn Infant; Outcome; Pathway interactions; Pharmaceutical Preparations; Population; Population trends; Postdoctoral Fellow; Pre-Eclampsia; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Prevention; Principal Investigator; Province; Public Health; Regimen; Research; Risk Factors; Role; Rural; Safety; Sentinel; Severities; Site; Small for Gestational Age Infant; South Africa; South African; Specialist; Sustainable Development; Training; Universities; Weight; Woman; adverse birth outcomes; antenatal; antiretroviral therapy; career; career development; cohort; data harmonization; electronic data; experience; high risk infant; improved; in utero; infant morbidity/mortality; infant outcome; low and middle-income countries; maternal morbidity; mortality; neonatal morbidity; neonatal outcome; pregnancy hypertension; pregnant; prenatal exposure; prevent; research study; skills; stillbirth; success; transmission process; trend; uptake

Project Summary Candidate: Dr. Slogrove is unwaveringly committed to a career focused on finding solutions to maternal and child health challenges in low-middle income countries (LMIC). She ultimately envisions herself globally as a leader in HIV exposed uninfected (HEU) child research and locally as the leader of a rural maternal and child health research unit. Dr. Slogrove’s 5-year career development plan is focused on three specific areas: 1) to develop advanced epidemiologic skills building on doctoral and post-doctoral studies in epidemiology; 2) to strengthen leadership ability; 3) to expand maternal health expertise complementing pediatric specialist training to comprehensively research the maternal-child dynamic. This will be achieved through drawing on the strengths of four leading institutions with strong collaborative ties, Stellenbosch University, University of Cape Town, Columbia University and Harvard. Dr. Slogrove has assembled a highly experienced mentorship team combining expertise in maternal and child HIV clinical research with public health, epidemiology and biostatistics. Research: This study aims to understand epidemiologically whether HIV and antiretroviral therapy (ART) are associated with hypertensive disorders in pregnancy (HDP) and whether this represents a pathway to adverse maternal, birth and HEU infant outcomes. The specific aims are to determine: 1) whether maternal HIV and antenatal ART are associated with HDP; 2) the contribution of HDP in HIV-infected women to adverse maternal and birth outcomes; 3) the contribution of maternal morbidity and mortality and adverse birth outcomes to HEU neonatal and infant morbidity and mortality. This early career award study will be integrated within the NICHD-funded B-POSITIVE study, comprehensively evaluating the universal maternal ART strategy at a population level in the entire Western Cape Province of South Africa. Provincial surveillance through harmonization of existing provincial electronic routine data sources is combined with sentinel-site activities to investigate population trends in greater depth. This presents a unique opportunity to interrogate pathways of HEU infant vulnerability in a population where 19% of infants are in utero HIV and ART exposed. The current application utilizes the B-POSITIVE electronic harmonized data platform to evaluate the specific aims at a population level in the entire cohort of pregnant women in the Western Cape for a 2-year period (N≈190,000) and in greater depth at two sentinel sites (N≈17,000). Mediation analysis will be used to understand whether the adverse birth outcomes associated with antenatal ART are partly mediated by increased HDP and in turn whether they partly mediate neonatal and infant morbidity and mortality. This study will rapidly determine in an entire population whether widely used antenatal ART regimens are associated with HDP and whether this represents a pathway to adverse maternal and birth outcomes leading to excess HEU infant morbidity and mortality. Establishing the safety of ART during pregnancy is of critical public health importance for the 30% of pregnant South African women who are HIV-infected.

项目概要 候选人：斯洛格罗夫博士坚定不移地致力于为孕产妇和儿童寻找解决方案的职业生涯 中低收入国家 (LMIC) 的儿童健康挑战。她最终将自己设想为全球 艾滋病毒暴露未感染儿童研究的领导者，以及当地农村孕产妇和儿童的领导者 健康研究单位。 Slogrove 博士的 5 年职业发展计划重点关注三个具体领域：1) 在流行病学博士和博士后研究的基础上发展先进的流行病学技能； 2）到 加强领导能力； 3) 扩大孕产妇保健专业知识，补充儿科专家 培训全面研究母婴动态。这将通过借鉴来实现 斯泰伦博斯大学、开普大学这四所具有密切合作关系的领先机构的优势 镇、哥伦比亚大学和哈佛大学。斯洛格罗夫博士组建了一支经验丰富的导师团队 将孕产妇和儿童艾滋病毒临床研究的专业知识与公共卫生、流行病学和 生物统计学。 研究：本研究旨在从流行病学角度了解 HIV 和抗逆转录病毒治疗 (ART) 是否有效 与妊娠期高血压疾病 (HDP) 相关，以及这是否是导致不良反应的途径 孕产妇、出生和 HEU 婴儿结局。具体目标是确定：1​​) 孕产妇是否感染艾滋病毒 产前 ART 与 HDP 相关； 2) HDP 在 HIV 感染女性中对不良反应的贡献 孕产妇和出生结果； 3) 孕产妇发病率和死亡率以及不良分娩的贡献 HEU 新生儿和婴儿发病率和死亡率的结果。这项早期职业奖励研究将被整合 在 NICHD 资助的 B 阳性研究中，全面评估通用孕产妇 ART 策略 南非整个西开普省的人口水平。省级监察通过 现有省级电子常规数据源的协调与哨点活动相结合， 更深入地调查人口趋势。这提供了一个独特的机会来询问路径 HEU 婴儿在 19% 的婴儿在子宫内暴露于 HIV 和 ART 的人群中的脆弱性。目前的 应用程序利用 B-POSITIVE 电子协调数据平台来评估特定目标 西开普省整个孕妇群体两年内的人口水平（N≈190,000） 并在两个哨点位置进行更深入的研究（N≈17,000）。中介分析将用于了解是否 与产前 ART 相关的不良出生结局部分是由 HDP 增加介导的，反过来 它们是否部分介导新生儿和婴儿的发病率和死亡率。这项研究将迅速确定 整个人群广泛使用的产前 ART 方案是否与 HDP 相关，以及这是否 是导致不良孕产妇和分娩结果的途径，导致高浓铀婴儿发病率过高， 死亡。对于 30% 的人来说，确定妊娠期间 ART 的安全性对于公共卫生至关重要 感染艾滋病毒的南非孕妇。