Maternal and Developmental Risks from Environmental and Social Stressors (MADRES)

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PROJECT SUMMARY/ABSTRACT—OVERALL CENTER Eliminating disparities in maternal health outcomes is a national priority, especially given the numerous adverse health sequelae. Moreover, pregnancy may be an underappreciated period of susceptibility to environmental exposures and impacts on later maternal health outcomes. Given the lack of data on the relationships between prenatal exposures and stressors with postpartum maternal health, we will focus the renewal cycle for the Maternal And Developmental Risks from Environmental and Social Stressors (MADRES) Center on two maternal health outcomes of utmost concern: maternal depression and cardiovascular health in the years after childbirth. Depression is the leading cause of mental health-related morbidity worldwide, affecting approximately 300 million people and is nearly twice as prevalent among women than men. US Hispanic women, have unique risk factors relative to non-Hispanic women including overcoming stress associated with acculturation and under-utilization of mental health care services. In parallel, cardiovascular disease (CVD) remains the number one cause of mortality and the prevalence of CVD has continued to climb among US women despite greater awareness and prevention efforts. Cardiovascular conditions that arise during the prenatal period, such as preeclampsia and hypertension, may have persistent effects into the postpartum period and predict elevated risk of later life CVD. Despite this growing evidence, there is little to no research on whether exposure to environmental and social stressors during this vulnerable period may promote cardiovascular dysfunction or maternal depression years later. This is particularly important in California, where the burden of exposures is not evenly distributed, with Hispanic and African-American populations carrying the greatest burden of environmental exposures. Understanding risk factors for maternal depression and CVD among health disparity populations in the first 4 years postpartum is necessary to reduce the disproportionate burden of disease borne by these individuals. The MADRES Center will examine whether prenatal environmental exposures and social stressors lead to higher depression and/or cardiovascular risk factors postpartum and whether patterns in exposure disparities from the built environment and physical, chemical or social stressors at the residential and neighborhood level relate to individual-level characteristics including allostatic load. The MADRES Center combines three innovative research projects, a strong Community Engagement and Dissemination Core, a comprehensive Investigator Development Core, and a synergizing Administrative Core. The MADRES Center brings together clinical, environmental, social and public health scientists and community engagement professionals to create a world-class research program in environmental health disparities. Our collaborative, multi-disciplinary approach will address key gaps needed for timely and effective disease prevention strategies and recommendations for approaches to reduce maternal morbidity in the years following childbirth.