权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

An internet-based preconception cohort study in North America

北美基于互联网的孕前队列研究

基本信息

批准号：
10680455
负责人：
LAUREN A WISE
金额：
$ 67.87万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-14 至 2027-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10680455
关键词：
3-Dimensional Acute Adult Affect American Area Assisted Reproductive Technology Biological Markers Black race Buffers Child Chronic Cohort Studies Collection Conceptions Couples Data Discrimination Emotional Enrollment Ensure Ethnic Origin Etiology Female Financial Hardship Geography Hair Health Care Costs Health Services Accessibility Heterogeneity Hour Hydrocortisone Indigenous Infertility Infrastructure Internet Intervention Joints Life Life Cycle Stages Low Income Population Measures Mediating National Institute of Child Health and Human Development North America Occupational Occupations Online Systems Outcome Participant Patient Recruitments Patient Self-Report Perinatal Physiological Pilot Projects Pittsburgh Sleep Quality Index Population Pregnancy Pregnancy loss Prospective Studies Prospective cohort Prospective, cohort study Public Health Race Reproductive Health Research Risk Risk Factors Rotation Salivary Sampling Selection Bias Sleep Sleep Fragmentations Sleep disturbances Social support Spontaneous abortion Stratification Stress Teenagers Underrepresented Populations United States Woman Work actigraphy adverse childhood events aged alpha-amylase childhood adversity coronavirus disease cost cost efficient design ethnic disparity experience fitbit follow-up health goals high risk infertility treatment male men modifiable risk novel occupational stressor people of color perceived stress perinatal outcomes poor sleep public health intervention racial discrimination racial disparity racism recruit reproductive reproductive outcome shift work sleep health sleep onset sleep pattern sleep quality stressor subfertility success time-to-pregnancy treatment disparity

项目摘要

ABSTRACT About 15% of American couples experience infertility (time-to-pregnancy >12 months) and more than 20% of couples experience spontaneous abortion (SAB, pregnancy loss <20 weeks of gestation). Fertility treatment is costly and inaccessible to most Americans, particularly people of color and low-income individuals. Among those with access to treatment, fertility treatment has relatively low success rates and is associated with adverse perinatal outcomes. There are also large racial/ethnic disparities in treatment success rates. As infertility and SAB exact an emotional and financial toll on affected couples, identifying modifiable risk factors for these outcomes in both partners is an important public health goal. With previous support from the NICHD, we designed a web-based prospective cohort study to recruit, follow, and collect comprehensive data on couples attempting pregnancy. Some of our strongest findings to date pertain to poor sleep quality and stress in both partners. To build on this work, we are submitting a renewal application (R01-HD086742) to evaluate the influence of understudied sleep- and stress-related exposures on subfertility and SAB risk, explore putative mechanisms of effect, and examine the extent to which these factors explain existing race/ethnic disparities in subfertility and SAB. Pregnancy Study Online (PRESTO) is a web-based preconception cohort study in North America that has enrolled more than 16,000 females and nearly 4,000 male partners during the preconception period, with 20% of PRESTO participants identifying as Black, Indigenous, or People of Color (BIPOC). In this renewal application, we propose to enroll an additional 8,000 females to enhance power for more detailed analyses of sleep using the Pittsburgh Sleep Quality Index, selected stressors (e.g., childhood adversity, discrimination, financial hardship, COVID-related factors), and risk of subfertility and SAB. We also propose to collect and analyze more objective exposure data using sleep actigraphy (Fitbit Inspire 2) and stress biomarkers (hair cortisol and salivary alpha-amylase) in a subset of new participants. We will enroll an additional 2,000 male partners to enhance power for examining male exposures and joint effects in both partners. To ensure power for key hypotheses (e.g., reproductive effects of racial discrimination), we will oversample BIPOC participants. This renewal application builds on our previous work indicating that stress and sleep quality are important determinants of reproductive health. Our expanded focus on understudied stressors—in populations that are underrepresented in reproductive and perinatal research (e.g., males and BIPOC)—is novel and of high public health importance. Preconception enrollment minimizes misclassification, selection bias, and reverse causation, and captures early SABs (<8 weeks of gestation), a priority area for NICHD. The cohort’s prospective design, cost-efficient web- based infrastructure for participant recruitment and follow-up, geographic and racial/ethnic heterogeneity, and comprehensive collection of confounder data in both partners are added strengths. Results will generate data that can inform public health interventions to reduce the population burden of subfertility and SAB.

摘要大约15%的美国夫妇患有不孕症（怀孕时间>12个月），超过20%的美国夫妇患有不孕症。夫妇经历自然流产（SAB，妊娠期<20周的妊娠丢失）。生育治疗是对大多数美国人来说，尤其是有色人种和低收入者来说，这是昂贵和难以实现的。人中在获得治疗的情况下，生育治疗的成功率相对较低，围产期结果。在治疗成功率方面也存在巨大的种族/民族差异。由于不孕症和 SAB对受影响的夫妇进行了情感和经济损失，确定了这些可改变的风险因素在这两个伙伴中取得成果是一个重要的公共卫生目标。在NICHD之前的支持下，我们设计了一项基于网络的前瞻性队列研究，旨在招募、跟踪和收集关于试图怀孕迄今为止，我们的一些最强有力的发现与夫妻双方的睡眠质量差和压力有关。到在这项工作的基础上，我们提交了一份更新申请（R 01-HD 086742），以评估研究了睡眠和压力相关的暴露对生育力低下和SAB风险的影响，探索了影响，并检查这些因素在多大程度上解释了现有的种族/民族差异， SAB。Pregnancy Study Online（PRESTO）是一项在北美开展的基于网络的孕前队列研究，在孕前阶段，招募了超过16,000名女性和近4,000名男性伴侣，其中20% PRESTO参与者识别为黑人，土著人或有色人种（BIPOC）。在这次更新申请中，我们建议再招募8，000名女性，以增强对睡眠进行更详细分析的能力，匹兹堡睡眠质量指数，选择的压力源（例如，童年的不幸、歧视、经济困难困难，COVID相关因素），以及生育力低下和SAB的风险。我们还建议收集和分析更多使用睡眠活动记录仪（Fitbit Fitzaire 2）和压力生物标志物（头发皮质醇和唾液）的客观暴露数据 α-淀粉酶）。我们将再招募2,000名男性伴侣，检查男性暴露和双方共同影响的能力。确保关键假设的有力性 (e.g.,种族歧视的生殖影响），我们将对BIPOC参与者进行过度抽样。此续订应用程序建立在我们以前的工作表明，压力和睡眠质量是重要的决定因素，生殖健康。我们扩大了对未充分研究的压力源的关注-在未被充分代表的人群中在生殖和围产期研究中（例如，男性和BIPOC）-是新的，具有高度的公共卫生重要性。先入组可最大限度地减少错误分类、选择偏倚和反向因果关系， SAB（妊娠<8周），国家排雷中心的优先领域。队列的前瞻性设计，具有成本效益的网络- 基于基础设施的参与者招募和随访、地理和种族/民族异质性，以及全面收集双方的混杂数据是额外的优势。结果将生成数据这可以为公共卫生干预提供信息，以减少生育力低下和SAB的人口负担。

项目成果

期刊论文数量（69）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Association of income and education with fecundability in a North American preconception cohort.

DOI：
10.1016/j.annepidem.2020.07.004
发表时间：
2020-10
期刊：
Annals of epidemiology
影响因子：
5.6
作者：
Schrager NL;Wesselink AK;Wang TR;Hatch EE;Rothman KJ;Mikkelsen EM;Boynton-Jarrett RD;Wise LA
通讯作者：
Wise LA

A prospective study of preconception asthma and spontaneous abortion.