The effect of hypertensive disorders in pregnancy and HIV-infection on maternal, birth and infant outcomes in South Africa

南非妊娠期高血压疾病和艾滋病毒感染对孕产妇、分娩和婴儿结局的影响

• 批准号: 9395953
• 负责人: Amy Louise Slogrove
• 金额: $ 11.25万
• 依托单位: STELLENBOSCH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-22 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9395953
• 关键词: 37 weeks gestation; Anti-Retroviral Agents; Area; Automobile Driving; Award; Biometry; Birth; CD4 Lymphocyte Count; Child; Childhood; Clinical Research; Complement; Consequences of HIV; Country; Data; Data Collection; Data Sources; Development Plans; Disease; Eclampsia; Environment; Epidemiology; Female of child bearing age; Funding; General Population; Goals; HIV; HIV Infections; HIV therapy; HIV-exposed uninfected infant; Health; Hospitalization; Individual; Infant; Infant Mortality; Institution; Leadership; Low Birth Weight Infant; Maternal Health; Maternal Mortality; Maternal and Child Health; Mediating; Mediation; Mentors; Mentorship; Morbidity - disease rate; Mothers; National Institute of Child Health and Human Development; Neonatal Mortality; Newborn Infant; Outcome; Pathway interactions; Pharmaceutical Preparations; Population; Population trends; Postdoctoral Fellow; Pre-Eclampsia; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Prevention; Principal Investigator; Province; Public Health; Regimen; Research; Risk Factors; Role; Rural; Safety; Sentinel; Severities; Site; Small for Gestational Age Infant; South Africa; South African; Specialist; Sustainable Development; Training; Universities; Weight; Woman; antenatal; antiretroviral therapy; career; career development; cohort; electronic data; experience; high risk infant; improved; in utero; infant morbidity; infant outcome; low and middle-income countries; maternal morbidity; mortality; neonatal morbidity; neonatal outcome; pregnancy hypertension; pregnant; prenatal exposure; prevent; research study; skills; stillbirth; success; transmission process; trend; uptake

Project Summary Candidate: Dr. Slogrove is unwaveringly committed to a career focused on finding solutions to maternal and child health challenges in low-middle income countries (LMIC). She ultimately envisions herself globally as a leader in HIV exposed uninfected (HEU) child research and locally as the leader of a rural maternal and child health research unit. Dr. Slogrove’s 5-year career development plan is focused on three specific areas: 1) to develop advanced epidemiologic skills building on doctoral and post-doctoral studies in epidemiology; 2) to strengthen leadership ability; 3) to expand maternal health expertise complementing pediatric specialist training to comprehensively research the maternal-child dynamic. This will be achieved through drawing on the strengths of four leading institutions with strong collaborative ties, Stellenbosch University, University of Cape Town, Columbia University and Harvard. Dr. Slogrove has assembled a highly experienced mentorship team combining expertise in maternal and child HIV clinical research with public health, epidemiology and biostatistics. Research: This study aims to understand epidemiologically whether HIV and antiretroviral therapy (ART) are associated with hypertensive disorders in pregnancy (HDP) and whether this represents a pathway to adverse maternal, birth and HEU infant outcomes. The specific aims are to determine: 1) whether maternal HIV and antenatal ART are associated with HDP; 2) the contribution of HDP in HIV-infected women to adverse maternal and birth outcomes; 3) the contribution of maternal morbidity and mortality and adverse birth outcomes to HEU neonatal and infant morbidity and mortality. This early career award study will be integrated within the NICHD-funded B-POSITIVE study, comprehensively evaluating the universal maternal ART strategy at a population level in the entire Western Cape Province of South Africa. Provincial surveillance through harmonization of existing provincial electronic routine data sources is combined with sentinel-site activities to investigate population trends in greater depth. This presents a unique opportunity to interrogate pathways of HEU infant vulnerability in a population where 19% of infants are in utero HIV and ART exposed. The current application utilizes the B-POSITIVE electronic harmonized data platform to evaluate the specific aims at a population level in the entire cohort of pregnant women in the Western Cape for a 2-year period (N≈190,000) and in greater depth at two sentinel sites (N≈17,000). Mediation analysis will be used to understand whether the adverse birth outcomes associated with antenatal ART are partly mediated by increased HDP and in turn whether they partly mediate neonatal and infant morbidity and mortality. This study will rapidly determine in an entire population whether widely used antenatal ART regimens are associated with HDP and whether this represents a pathway to adverse maternal and birth outcomes leading to excess HEU infant morbidity and mortality. Establishing the safety of ART during pregnancy is of critical public health importance for the 30% of pregnant South African women who are HIV-infected.

项目摘要 候选人：Slogrove博士坚定不移地致力于职业生涯，专注于寻找解决孕产妇和 中低收入国家（LMIC）的儿童健康挑战。她最终设想自己在全球范围内作为一个 艾滋病毒暴露未感染儿童（HEU）研究的领导者，并在当地担任农村孕产妇和儿童的领导者 卫生研究单位。Slogrove博士的5年职业发展计划侧重于三个具体领域：1） 在流行病学博士和博士后研究的基础上发展先进的流行病学技能; 2） 加强领导能力; 3）扩大孕产妇健康专业知识，补充儿科专家 全面研究母婴动态的培训。这将通过借鉴 斯泰伦博斯大学、开普敦大学、四所具有强大合作关系的领先机构的优势 镇，哥伦比亚大学和哈佛。斯洛格罗夫博士组建了一支经验丰富的导师团队 将妇幼艾滋病毒临床研究的专门知识与公共卫生、流行病学和 生物统计学 研究：这项研究旨在从流行病学上了解艾滋病毒和抗逆转录病毒治疗（ART）是否是 与妊娠期高血压疾病（HDP）相关，以及这是否代表了不良反应的途径 产妇、分娩和高浓缩铀婴儿的结果。具体目标是确定：（1）产妇是否感染艾滋病毒， 产前ART与HDP相关; 2）HDP在HIV感染妇女中对不良反应的贡献 产妇和分娩结果; 3）产妇发病率和死亡率以及不良分娩的贡献 高浓缩铀对新生儿和婴儿发病率和死亡率的影响。这项早期职业奖励研究将与 在NICHD资助的B阳性研究中，全面评估普遍的孕产妇ART策略， 在整个南非西开普省的人口水平上。省级监测通过 将现有省级电子常规数据源的协调与哨点活动相结合， 更深入地调查人口趋势。这提供了一个独特的机会来询问 高浓缩铀婴儿在19%的婴儿在子宫内接触艾滋病毒和抗逆转录病毒疗法的人口中的脆弱性。当前 应用程序利用B-阳性电子协调数据平台来评估特定目标， 西开普省2年期间整个孕妇队列的人口水平（190 000奈拉） 在两个哨点（N = 17，000）的深度更大。调解分析将用于了解是否 与产前ART相关的不良出生结果部分由HDP增加介导， 它们是否部分介导新生儿和婴儿发病率和死亡率。这项研究将迅速确定 是否广泛使用产前抗逆转录病毒疗法与HDP有关， 是导致高浓缩铀婴儿发病率过高的孕产妇和分娩不良后果的途径， mortality.确定妊娠期间抗逆转录病毒疗法的安全性对30%的 感染艾滋病毒的南非孕妇。