Severe Maternal Morbidity: An Investigation of Racial-Ethnic Disparities, Social Disadvantage & Maternal Weight

严重的孕产妇发病率：对种族差异、社会弱势的调查

• 批准号: 10091301
• 负责人: SUZAN L CARMICHAEL
• 金额: $ 20.08万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-19 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10091301
• 关键词: Address; Affect; Area; Asians; Biological; Birth; Body Weight Changes; California; Cardiovascular system; Centers for Disease Control and Prevention (U.S.); Child Care; Clinical; Complex; Conceptions; Data; Development; Eclampsia; Ethnic Origin; Future; Goals; Guidelines; Health; Hispanics; Hospitals; Household; Individual; Infant; Intervention; Investigation; Knowledge; Life; Life Cycle Stages; Maternal Health; Mediating; Mothers; Neighborhoods; Not Hispanic or Latino; Obesity; Outcome; Population; Postpartum Hemorrhage; Postpartum Period; Pre-Eclampsia; Pregnancy; Prevalence; Public Health; Race; Records; Research; Risk; Sepsis; Severities; Underweight; Weight; Weight Gain; Woman; base; high risk; indexing; maternal weight; parent grant; perinatal outcomes; racial and ethnic disparities; severe maternal morbidity; social determinants; social disadvantage

ABSTRACT (from parent grant R01 NR017020) Severe Maternal Morbidity (SMM) includes serious threats to maternal health and survival that occur at delivery or postpartum. Based on the SMM index developed by CDC that focuses on the most life--threatening conditions and complications, the prevalence of SMM doubled from 1998-2011 and currently affects >65,000 women in the U.S. each year. Maternal health is essential to a woman’s ability to care for her children and to her health over her life course, yet our understanding of causes of SMM is limited. This proposal addresses three key and understudied areas of research for SMM: racial/ethnic disparities, maternal weight, and social disadvantage. Racial/ethnic disparities in SMM and its contributing conditions are well known – risk of SMM tends to be up to 2-fold higher among non-Hispanic blacks and 1.5-fold higher among Hispanics and Asians, relative to non-Hispanic whites. The explanation for these disparities is unknown, but preliminary evidence suggests that maternal weight and social disadvantage may contribute. In the U.S., 25% of women are obese at conception, half gain excessive weight during pregnancy, and 25% retain >10 lb. postpartum, but this varies by race--ethnicity. Some studies suggest an association of obesity with SMM, but few have examined severity of obesity, underweight status, or weight change. Social disadvantage is much more common among non--whites than whites and associated with myriad perinatal outcomes, but almost no studies have examined its contribution to SMM. Unusually high and low maternal weight and weight gain are most likely among socially disadvantaged women, but their inter-related impacts on SMM have not been studied. Our goal is to increase understanding of biologic and social determinants of SMM and its racial/ethnic disparities, by analyzing 4 million births that occurred in California from 2007--2014. The data include vital records and mother and infant hospital discharge data from pregnancy through postpartum. Outcomes will include the most common conditions that contribute to SMM – postpartum hemorrhage, eclampsia/severe preeclampsia, select cardiovascular conditions, and sepsis – as well as the SMM index developed by CDC. The Specific Aims are: 1) Examine associations of maternal weight status before, during, and between pregnancies with SMM and whether they are modified by race/ethnicity; 2) Examine associations of multi-level (individual, household, neighborhood) indicators of social disadvantage with SMM, overall and by race/ethnicity (Aim 2a), and the extent to which these relationships are mediated by maternal weight status (Aim 2b); and 3) Investigate the contribution of maternal weight status and social disadvantage to the population burden of SMM and its racial/ethnic disparities. The proposed research will break new ground by studying the complex relationships among maternal weight, social disadvantage, racial/ethnic disparities, and SMM. This knowledge is essential to the development of effective public health and clinical interventions to reduce SMM and its disparities, including guidelines for maternal weight.

摘要（来自父母赠款R01 NR017020） 严重的孕产妇发病率（SMM）包括对生物健康和生存的严重威胁 分娩或产后。基于CDC开发的SMM索引，该指数侧重于生命 - 威胁性 条件和并发症，SMM的患病率从1998 - 2011年翻了一番，目前影响> 65,000 每年在美国的妇女。孕产妇的健康对于女人照顾孩子的能力至关重要 她在她的人生过程中的健康状况，但是我们对SMM原因的理解是有限的。该提案解决了 SMM的三个关键和理解的研究领域：种族/种族分布，孕产妇体重和 社会劣势。 SMM及其贡献条件的种族/种族差异是众所周知的 - 在非西班牙裔黑人中，SMM往往高达2倍，而西班牙裔和西班牙裔则高1.5倍 相对于非西班牙裔白人，亚洲人。这些分布的解释尚不清楚，但初步 有证据表明，物质体重和社会灾难可能会造成任何贡献。在美国，有25％的妇女 肥胖，怀孕期间的体重超过一半，25％保持> 10磅的产后，但 种族的这种品种 - 种族。一些研究表明肥胖与SMM的关联，但很少有人 检查了肥胖，体重不足或体重变化的严重程度。社会灾难更多 在非白人中比白人常见，并且与无数的围产期结局有关，但几乎没有研究 已经检查了其对SMM的贡献。异常高和低的产妇体重和体重增加最多 在受到社会打扰的妇女中，她们对SMM的相互影响的影响尚未研究。 我们的目标是增加对SMM及其种族/种族的生物学和社会决定者的理解 差距，分析2007年至2014年在加利福尼亚州发生的400万个出生。数据包括至关重要 记录以及母亲和婴儿医院的出院数据从怀孕到产后。结果会 包括有助于SMM的最常见疾病 - 产后出血，Eclampsia/Recary 子痫前期，选择心血管疾病和败血症 - 以及CDC开发的SMM指数。 具体目的是：1）检查孕产妇体重状况的关联 患有SMM的怀孕以及是否通过种族/种族来修改； 2）检查多层次的关联 （个人，家庭，社区）与SMM，整体和种族/种族的社会灾难指标 （AIM 2A），以及这些关系是由母校体重状况介导的（AIM 2B）的程度； 3） 调查产妇体重状况和社会灾难对人口燃烧的贡献 SMM及其种族/种族差异。拟议的研究将通过研究复合物来打破新的基础 母校体重，社会灾难，种族/种族差异和SMM之间的关系。这个知识 对于开发有效的公共卫生和临床干预措施以减少SMM及其临床干预措施至关重要 差异，包括材料重量指南。