Cesarean delivery in overweight and obese women: patient and systems factors

描述（由申请人提供）：该 K99/R00 奖将提供将候选人培养成为专注于生殖健康差异的独立跨学科研究人员所需的卫生服务研究和临床产科实践方面的培训。在美国，剖腹产率已达到流行病的程度。超重和肥胖的女性剖腹产的风险以及剖腹产后的短期和长期发病风险增加。然而，对于如何为超重/肥胖女性提供最佳产科护理，以最大限度地提高她们成功阴道分娩的机会，人们知之甚少。患者和系统层面的因素是交付方式的重要决定因素。剖腹产存在种族/民族差异，肥胖和种族的相对影响尚不清楚。此外，人们对临产和分娩的繁忙（高产量）天对剖腹产率的影响知之甚少。该项目旨在理清肥胖和种族/民族的影响，并确定每日产科量对剖腹产的影响。拟议的 K99/R00 研究将使用包含不同出生人口（加利福尼亚州）的大型管理数据集来梳理肥胖和种族/民族对分娩方式的影响，探索效果修改的可能性。已经观察到肥胖和种族对其他产科结果的这种相互作用。 K99 阶段将允许候选人制定每日产科量的指标，或者特定日期分娩部门的繁忙程度。在 R00 阶段，考生将分析高产量天数对初产率、足月产率、单胎产率、顶点剖宫产率的影响。还将在超重/肥胖人群和少数族裔女性亚群体中进行分析，看看产科护理过程的改变是否会对其结果产生不同的影响。这些创新的分析和方法将为不良妊娠结局风险最大的女性剖腹产的非医学预测因素提供急需的信息。俄勒冈健康与科学大学是进行此类培训和研究的理想场所，因为它在临床产科、产科结果研究和卫生服务研究方面处于领先地位。候选人还将利用俄勒冈临床和转化研究所的资源来促进专业发展并促进向研究独立性的过渡。

DESCRIPTION (provided by applicant): This K99/R00 Award will provide the training in health services research and clinical obstetric practice needed to develop the candidate into an independent interdisciplinary researcher focusing on reproductive health disparities. The rate of cesarean delivery has reached epidemic proportions in the U.S. Overweight and obese women are at increased risk of cesarean, as well as short-term and long-term morbidities subsequent to cesarean delivery. However, very little is known about how to optimally provide obstetric care to overweight/obese women, to maximize their chance of successfully achieving a vaginal delivery. Patient- and systems-level factors are important determinants of mode of delivery. There are racial/ethnic disparities in cesarean delivery, and the relative contribution of obesity and race i unknown. Additionally, very little is known about the effect of busy (high-volume) days in Labor & Delivery on cesarean delivery rates. This project aims to disentangle the effects of obesity and race/ethnicity, and establish the impact of daily obstetric volume, on cesarean delivery. The proposed K99/R00 study will use a large administrative dataset containing a diverse population of births (California) to tease out the impact of obesity and race/ethnicity on mode of delivery, exploring the possibility of effect modification. Interaction of this type has been observed for obesity and race effects on other obstetric outcomes. The K99 phase will allow the candidate to develop a metric of daily obstetric volume, or how busy a Labor & Delivery unit is on a given day. In the R00 phase, the candidate will analyze the impact of high-volume days on the nulliparous, term, singleton, vertex cesarean delivery rate. Analyses will also be conducted within the overweight/obese populations and among subgroups of racial minority women, to see if altered processes of obstetric care affect their outcomes differentially. These innovative analyses and methodologies will provide much-needed information on non-medical predictors of cesarean delivery among women at the greatest risk of adverse pregnancy outcomes. Oregon Health and Science University is the ideal setting to conduct this training and research, because of its leadership in clinical obstetrics, obstetric outcomes research, and health services research. The candidate will also leverage the resources at the Oregon Clinical and Translational Research Institute to foster professional development and facilitate the transition to research independence.