Project 2: Disparities-Aware Classifiers for Maternal and Infant Health

摘要 妇女在怀孕期间的健康状况影响到她及其婴儿的短期和长期健康。在 事实上，早产是美国健康的主要指标，因为它对新生儿的破坏性影响。 死亡率和发病率，估计每年的经济损失超过250亿美元。尽管 过去十年在将早产年发生率降至10%以下方面取得的进展， 不平等现象依然存在，对改善孕产妇和儿童健康构成重大挑战， 妊娠期高血压疾病（HDP），包括子痫、先兆子痫、 和妊娠期高血压，影响高达10%的怀孕，并像早产，增加产妇的风险 死亡率和发病率远远超过产后时期。存在着严重的种族差异， 非裔美国人（AA）妇女早产和死于HDP的风险最大， 传统的风险因素（例如，母亲的社会人口学特征，行为， 生育史和获得高质量医疗保健的机会）并不能完全解释早产的种族差异， 其他产科结果。为了阐明这些种族差异的决定因素，我们必须考虑 更广泛的生物，物理，社会和建筑环境，可能会影响妇女的健康，并走向一个 综合评估这些因素，以更准确地预测风险。休斯顿的孕妇是一个 风险人群。作为一个石化中心和美国第四大城市，休斯顿是一个缩影， 构成“环境风险景观”的生物、物理、社会和建筑环境因素。 定义早产和其他产科结局的潜在风险特征将告知我们的理解 这些结果在休斯敦和全国各地的差异人口的种族差异的决定因素。 本研究项目的总体目标是，孕产妇和婴儿健康的差异意识分类器， 是开发“意识到危险性”的分类器，使用包容性 环境风险景观框架。为此，我们将在独特的Peribank基础上进行研究 贝勒医学院的资源，以获取母体生物[循环无细胞RNA（cfRNA）]数据 和微生物组]和化学品（多环芳烃和金属）暴露，以及社会和建筑的特点， 环境.这些数据将用于识别可整合到AA和非AA中的信息特征。 西班牙裔白色人（NHW）早产和HDP的出生率感知分类器。预测性安全感知 依赖于个人和地方层面压力源属性的分类器有可能识别主要的压力源， AA和NHW妇女中早产和HDP的驱动因素，并为制定干预措施提供指导 减少差距，改善妇女及其婴儿的健康和福祉。

ABSTRACT A woman’s wellbeing during pregnancy affects her short- and long-term health as well as that of her infant. In fact, preterm delivery is a leading indicator of health in the U.S. because of its devastating impacts on neonatal mortality and morbidity with estimated economic costs that exceed 25 billion dollars each year. Despite advances over the last decade in reducing the annual prevalence of preterm birth to under 10%, persistent racial inequities remain that pose significant challenges to improving maternal and child health among health disparity populations in the U.S. Hypertensive disorders of pregnancy (HDP), which consist of eclampsia, preeclampsia and gestational hypertension, affect up to 10% of pregnancies and, like preterm delivery, increase maternal risks of mortality and morbidity that extend far beyond post-partum periods. Significant racial disparities exist, with African-American (AA) women at greatest risk for preterm birth and for dying from HDP than any other racial or ethnic group in the U.S. Traditional risk factors (e.g., maternal sociodemographic characteristics, behaviors, reproductive history and access to quality health care) do not fully explain racial disparities in preterm birth or other obstetric outcomes. To elucidate determinants of these racial disparities, we must consider aspects of the broader biological, physical, social and built environments that may affect women’s health, and move toward an integrated assessment of these factors to more accurately predict risk. Pregnant women in Houston are an at risk population. As a petrochemical hub and fourth largest city in the U.S., Houston is a microcosm for identifying factors of the biological, physical, social, and built environments that constitute the “environmental riskscape”. Defining riskscape features underlying preterm birth and other obstetric outcomes will inform our understanding of determinants of racial disparities in these outcomes in Houston and for disparity populations across the nation. The overall Objective of this Research Project, Disparities-aware Classifiers for Maternal and Infant Health, is to develop “disparities-aware” classifiers that identify major drivers of preterm birth and HDP using an inclusive environmental riskscape framework. To do so, we will conduct a study building upon the unique PeriBank resource at Baylor College of Medicine to acquire data on maternal biological [circulating cell-free RNA (cfRNA) and microbiome] and chemical (PAH and metal) exposures, as well as features of the social and built environments. These data will be used to identify informative features that can be integrated into AA and non- Hispanic white (NHW) disparities-aware classifiers for preterm birth and HDP. Predictive disparities-aware classifiers that rely on attributes of individual- and place-level stressors have the potential for identifying major drivers of preterm birth and HDP among AA and NHW women and provide direction for developing interventions to mitigate disparities and improve the health and well-being of women and their infants.