Understanding the contributions of stress reactivity to racial disparities in adverse placental and pregnancy outcomes

摘要 越来越多的研究表明，母亲的压力是不良反应负担增加的一种解释。 非西班牙裔黑人女性与非西班牙裔白色女性相比的妊娠结局（APO） 同行大多数探索压力和APO之间关系的研究都只关注 在产前暴露于压力源，但黑人妇女一般暴露于更多的压力，在生活中 当然比白色女人多。此外，黑人妇女可能拥有更有限的资源来科普社会问题。 压力源，以及更有可能经历持久的压力源，如种族和/或性别歧视， 这可能导致对日常紧张性刺激的生理和心理反应失调（即，应力 反应性）。几项研究表明，心血管，神经内分泌和情感反应失调， 压力源与非妊娠妇女心血管疾病风险增加和其他不良健康结果相关 但压力反应失调对妊娠结局的影响仍然很小 明白因此，本研究的总体目标是检查生理和心理的影响， 对不良胎盘和妊娠结局的应激反应。我们将利用生态瞬间 评估和密集测量心率变异性、血压、唾液皮质醇， 积极和消极的影响，以产生个性化的措施，孕妇如何应对压力 在日常生活中的经历。然后，我们将研究这些措施与不良胎盘 病变和妊娠结局。最后，我们将量化压力反应和暴露于 怀孕期间的压力因素导致了这些不良结果的种族差异。

ABSTRACT A growing number of studies has implicated maternal stress as an explanation for the higher burden of adverse pregnancy outcomes (APOs) seen among non-Hispanic Black women compared with their non-Hispanic White counterparts. Most studies that have explored the relationship between stress and APOs have focused solely on prenatal exposure to stressors, but Black women are generally exposed to more stressors over the life course than White women. Moreover, Black women may have more limited resources to cope with social stressors, as well as be more likely to experience enduring stressors like racial and/or gender discrimination, which may lead to dysregulated physiological and psychological responses to everyday stressors (i.e., stress reactivity). Several studies have shown dysregulated cardiovascular, neuroendocrine, and affective reactivity to stressors is associated with increased CVD risk and other adverse health outcomes in non-pregnant populations, but the impact of dysregulated stress reactivity on pregnancy outcomes remains poorly understood. Thus, the overall goal of this study is to examine the impact of physiological and psychological stress reactivity on adverse placental and pregnancy outcomes. We will use ecological momentary assessments and intensive measurements of heart rate variability, blood pressure, salivary cortisol, and positive and negative affect to generate personalized measures of how pregnant women respond to stressful experiences in their daily lives. We will then examine associations of these measures with adverse placental lesions and pregnancy outcomes. Finally, we will quantify the extent to which stress reactivity and exposure to stressors during pregnancy account for racial disparities in these adverse outcomes.