Maternal Resilience to Stress, Neonatal Outcomes, and Racial/Ethnic Health Disparities

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PROJECT SUMMARY Training: The purpose of this K23 proposal is to prepare Dr. Diana Montoya-Williams for a career as an independent clinician scientist. Her long-term career objectives are to contribute to the development of policies and interventions that diminish health disparities among pregnant minority women and their infants. Her immediate goal is to obtain the knowledge and skills to complete rigorous longitudinal studies of maternal-infant dyads aimed at defining assets that protect women against adverse neonatal outcomes. To meet these goals, Dr. Montoya-Williams and her mentor team have devised a career development plan that integrates: 1) intensive mentorship from successful investigators; 2) focused training in longitudinal cohort and statistical path analyses; and 3) innovative research on the relationship between resilience, stress and adverse neonatal outcome disparities. Research: Significant racial, ethnic and nativity-related disparities exist for birth weight, gestational length and breastfeeding in the U.S. and have major implications for our elevated infant mortality rates. Maternal psychosocial stress has been linked to these adverse neonatal outcomes and is disproportionately experienced by minority women. Resilience is the ability to respond to stress and appears to change in the face of stressors. Higher resilience has been linked to improved outcomes in conditions like diabetes and cardiovascular disease; there is also evidence that resilience can be improved. However, our knowledge of resilience in pregnancy is scarce and a major limitation is the cross-sectional nature of existing data. It is not clear whether resilience changes through the course of pregnancy and whether it modifies the relationship that exists between maternal stress and adverse neonatal outcomes. In addition, resilience may vary by race, ethnicity and nativity but data is limited. Dr. Montoya-Williams’ mentored research will address these key knowledge gaps. By creating a diverse longitudinal cohort of pregnant women, she will: 1) explore the association between resilience, three different types of perceived self-reported stress (acute, intermediate chronic and remote traumatic) and the physiologic manifestations of stress (i.e. allostatic load) at the onset of pregnancy; 2) describe whether resilience measured repeatedly in pregnancy changes in response to acute pregnancy-related stressors; and 3) investigate associations between the trajectory of resilience in pregnancy and adverse neonatal outcomes. Importantly, she will describe any differences that may exist in these relationships for women of different ethnoracial and cultural backgrounds. Summary: Findings from this study will inform an R01 proposal to test resilience interventions that may mitigate the stress-related drivers of neonatal health disparities. Through this award, Dr. Montoya-Williams will also emerge as a leading independent clinician scientist contributing to the amelioration of neonatal racial/ethnic health disparities.