Maternal Resilience to Stress, Neonatal Outcomes, and Racial/Ethnic Health Disparities

项目摘要 培训：本K23提案的目的是为Diana Montoya-Williams博士的职业生涯做好准备 独立临床科学家。她的长期职业目标是为发展 减少少数群体孕妇及其婴儿之间健康差距的政策和干预措施。 她的直接目标是获得知识和技能，以完成严格的纵向研究， 母婴配对，旨在界定保护妇女免受不利新生儿后果影响的资产。到 为了实现这些目标，蒙托亚-威廉姆斯博士和她的导师团队设计了一个职业发展计划， 它整合了：1）来自成功调查人员的密集指导; 2）纵向的重点培训 队列和统计路径分析;以及3）关于弹性之间关系的创新研究， 压力和不良新生儿结局差异。 研究：出生体重、妊娠期长短存在明显的种族、民族和与出生地相关的差异 和母乳喂养在美国，并对我们的婴儿死亡率上升有重大影响。产妇 心理社会压力与这些不良新生儿结局有关， 少数民族妇女的经历。弹性是应对压力的能力，并且似乎会随着时间的推移而变化。 面对压力。更高的韧性与改善糖尿病等疾病的结果有关， 心血管疾病;也有证据表明，弹性可以提高。然而，我们对 怀孕期间的复原力很少，一个主要的限制是现有数据的跨部门性质。是 不清楚弹性是否在怀孕过程中发生变化，以及它是否会改变 产妇压力与新生儿不良结局之间存在的关系。此外，弹性 可能因种族、族裔和出生地而异，但数据有限。蒙托亚-威廉姆斯博士的指导研究将 解决这些关键的知识差距。通过创建一个多样化的纵向孕妇队列，她将： 1)探索弹性，三种不同类型的自我报告压力（急性， 中度慢性和远程创伤）和应激的生理表现（即非稳态负荷） 2）描述在怀孕期间反复测量的弹性是否会改变， 对急性妊娠相关应激源的反应;以及3）调查 怀孕和新生儿不良后果的恢复力。重要的是，她将描述任何差异， 对于不同种族和文化背景的妇女来说，这些关系中可能存在的问题。 总结：这项研究的结果将为R 01提案提供信息，以测试可能 减轻新生儿健康差距的压力相关驱动因素。通过这个奖项，蒙托亚-威廉姆斯博士 也将成为一个领先的独立的临床科学家有助于改善新生儿 种族/民族健康差异。

PROJECT SUMMARY Training: The purpose of this K23 proposal is to prepare Dr. Diana Montoya-Williams for a career as an independent clinician scientist. Her long-term career objectives are to contribute to the development of policies and interventions that diminish health disparities among pregnant minority women and their infants. Her immediate goal is to obtain the knowledge and skills to complete rigorous longitudinal studies of maternal-infant dyads aimed at defining assets that protect women against adverse neonatal outcomes. To meet these goals, Dr. Montoya-Williams and her mentor team have devised a career development plan that integrates: 1) intensive mentorship from successful investigators; 2) focused training in longitudinal cohort and statistical path analyses; and 3) innovative research on the relationship between resilience, stress and adverse neonatal outcome disparities. Research: Significant racial, ethnic and nativity-related disparities exist for birth weight, gestational length and breastfeeding in the U.S. and have major implications for our elevated infant mortality rates. Maternal psychosocial stress has been linked to these adverse neonatal outcomes and is disproportionately experienced by minority women. Resilience is the ability to respond to stress and appears to change in the face of stressors. Higher resilience has been linked to improved outcomes in conditions like diabetes and cardiovascular disease; there is also evidence that resilience can be improved. However, our knowledge of resilience in pregnancy is scarce and a major limitation is the cross-sectional nature of existing data. It is not clear whether resilience changes through the course of pregnancy and whether it modifies the relationship that exists between maternal stress and adverse neonatal outcomes. In addition, resilience may vary by race, ethnicity and nativity but data is limited. Dr. Montoya-Williams’ mentored research will address these key knowledge gaps. By creating a diverse longitudinal cohort of pregnant women, she will: 1) explore the association between resilience, three different types of perceived self-reported stress (acute, intermediate chronic and remote traumatic) and the physiologic manifestations of stress (i.e. allostatic load) at the onset of pregnancy; 2) describe whether resilience measured repeatedly in pregnancy changes in response to acute pregnancy-related stressors; and 3) investigate associations between the trajectory of resilience in pregnancy and adverse neonatal outcomes. Importantly, she will describe any differences that may exist in these relationships for women of different ethnoracial and cultural backgrounds. Summary: Findings from this study will inform an R01 proposal to test resilience interventions that may mitigate the stress-related drivers of neonatal health disparities. Through this award, Dr. Montoya-Williams will also emerge as a leading independent clinician scientist contributing to the amelioration of neonatal racial/ethnic health disparities.