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

项目概要 培训：此 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做出贡献 缩小少数族裔怀孕妇女及其婴儿健康差距的政策和干预措施。 她的近期目标是获得知识和技能来完成严格的纵向研究 母婴二元关系旨在确定保护妇女免受不良新生儿后果影响的资产。至 为了实现这些目标，蒙托亚-威廉姆斯博士和她的导师团队制定了职业发展计划 其中包括：1）成功研究者的强化指导； 2）纵向集中训练 队列和统计路径分析； 3）关于复原力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、妊娠长度存在显着的种族、民族和出生相关差异 和美国的母乳喂养，对我们婴儿死亡率的升高有重大影响。产妇 社会心理压力与这些不良新生儿结局有关，并且不成比例地 少数民族妇女所经历的。复原力是指对压力做出反应并在环境中发生变化的能力 面对压力源。更高的复原力与糖尿病等疾病的改善结果有关 心血管疾病；还有证据表明复原力是可以提高的。然而，我们的知识 怀孕期间的复原力很少，主要限制是现有数据的横截面性质。它是 尚不清楚弹性是否会在怀孕过程中发生变化以及是否会改变 母亲压力与不良新生儿结局之间存在关系。另外，韧性 可能因种族、民族和出生地而异，但数据有限。蒙托亚-威廉姆斯博士指导的研究将 解决这些关键的知识差距。通过创建一个多样化的孕妇纵向队列，她将： 1) 探索复原力与三种不同类型的自我报告压力（急性、 中度慢性和远期创伤）和应激的生理表现（即稳态负荷） 怀孕初期； 2) 描述怀孕期间反复测量的弹性是否发生变化 对与妊娠相关的急性应激源的反应； 3）研究轨迹之间的关联 妊娠恢复力和不良新生儿结局。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。 摘要：这项研究的结果将为 R01 提案提供信息，以测试可能的弹性干预措施 减轻与压力相关的新生儿健康差异的驱动因素。蒙托亚-威廉姆斯博士通过该奖项 也将成为一位领先的独立临床科学家，为改善新生儿疾病做出贡献 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.