Personalized care for prenatal stress reduction and preterm birth prevention

减轻产前压力和预防早产的个性化护理

• 批准号: 10608372
• 负责人: Rebecca Fry
• 金额: $ 66.09万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-15 至 2028-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10608372
• 关键词: Address; Adherence; Affect; Biological; Biological Markers; Biology; Black race; Blood; Caring; Clinic; Data; Discipline of obstetrics; Discrimination; Disparity; Enrollment; Evidence based intervention; Financial Support; Frequencies; Functional disorder; Gene Expression; Genes; Gestational Age; Goals; Health; Health Services Accessibility; Infant; Intervention; Knowledge; Life; Measures; Medical; Medicine; Membrane; Mission; Modality; National Institute on Minority Health and Health Disparities; Neonatal Mortality; Outcome; Patients; Perinatal; Pharmaceutical Preparations; Pre-Eclampsia; Pregnancy; Premature Birth; Prenatal care; Prevention; Prevention program; Provider; Psychosocial Assessment and Care; Public Health; Publishing; Race; Randomized; Randomized, Controlled Trials; Reporting; Research; Risk; Risk Factors; Rupture; Screening Result; Social support; Stress; Surveys; Survivors; Testing; Transcript; Vision; Visit; Work; adverse childhood events; allostatic load; black patient; black women; cohort; efficacy evaluation; efficacy testing; evidence base; high risk; improved; improved outcome; indexing; insight; medical specialties; neonatal morbidity; novel; patient navigator; patient subsets; perceived stress; personalized care; pregnant; premature; prenatal stress; programs; promote resilience; psychosocial; racism; recruit; resilience; satisfaction; standard of care; stress reduction; stressor; treatment as usual

PROJECT ABSTRACT This project addresses the critical barrier of solutions for preterm birth (PTB) by deploying a deploying a novel, personalized, comprehensive 3-tier PTB prevention program (UNC PTBCARE+) to reduce perinatal stress. There are significant PTB disparities; Black pregnant patients are 49% more likely to deliver preterm, have a higher risk of PTB at earlier gestational ages, report higher perceived stress, and have higher allostatic loads compared to patients of other races. UNC PTBCARE+ addresses stress and related mechanistic underpinnings of PTB. Our long-term goal is to refine and widely deploy an evidence-based intervention to mitigate stress during pregnancy and reduce PTB. The objective is to test, in a randomized controlled trial that will enroll 1,509 pregnant patients, whether our UNC PTBCARE+ program that provides a specific stress reduction toolkit and a PTB Care Coordinator (Tier 1, all patients randomized to UNC PTBCARE+), Enhanced Psychosocial support (Tier 2a level support, subset of patients who screen positive at randomization), Financial support (Tier 2b level support, subset of patients who screen positive at randomization), or both (Tier 3 level support) is associated with stress reduction (assessed subjectively by validated surveys and objectively by biomarkers), and PTB <35 weeks. Further, we will examine which interventions are most helpful, and will evaluate whether results vary by race. Our central hypothesis is that enrollment in our personalized, comprehensive PTB care program (UNC PTBCARE+) is associated with reduced stress, stress-related gene expression, allostatic load, and rates of PTB <35 weeks. We further hypothesize that UNC PTBCARE+ will most benefit non-White patients due to racism-associated stress, and that biologic analyses will provide key objective insight into the mechanisms underlying stress-related PTB and the impact of the intervention. This hypothesis is based upon our preliminary data indicating: (a) pregnant patients at UNC at high risk for PTB have high rates of stress and life stressors (e.g., financial insecurity, extreme racism), (b) biologic stress markers including gene transcript levels differ by PTB status in mid-pregnancy blood, (c) reduced stress among patients receiving specialty PTB prenatal care in a NC cohort. Building upon our prior work and that of others, this exciting proposal will identify which aspects of the UNC PTBCARE+ program are most critical for stress-related PTB reduction. We test our hypothesis through the following aims: Aim 1- Evaluate the effects of the UNC PTBCARE+ program on perceived stress and resilience in pregnant patients at high risk for PTB; Aim 2- Quantify the extent to which the UNC PTBCARE+ program is associated with improved biologic stress measures during pregnancy; Aim 3- Determine the effects of the UNC PTBCARE+ program on PTB <35 weeks. This study provides tangible, personalized solutions to the major public health problem of PTB and carries enormous potential to provide generalizable, low-risk strategies to reduce PTB and PTB related disparities.

项目摘要 该项目通过部署部署来解决早产（PTB）的关键解决方案（PTB） 一种新颖，个性化的，全面的3层PTB预防计划（UNC PTBCARE+），以减少 围产应力。 PTB差异很大；黑人怀孕患者提供的可能性高49％ 早产，在早期胎龄患PTB的风险较高，报告的压力更高，并且具有更高 与其他种族的患者相比，同级负荷。 UNC PTBCARE+解决了压力和相关机理 PTB的基础。我们的长期目标是完善并广泛部署基于证据的干预措施 减轻怀孕期间的压力并减少PTB。目的是在一项随机对照试验中测试 无论我们的UNC PTBCARE+计划提供特定的压力 还原工具包和PTB护理协调员（第1层，所有患者随机分为UNC PTBCARE+），增强 社会心理支持（2A级支持，随机分配阳性阳性的患者子集），财务 支持（2B级支持，随机筛选阳性的患者的子集）或两者（第3级水平） 支持）与减轻压力有关（通过经过验证的调查进行主观评估，并通过客观地评估 生物标志物）和PTB <35周。此外，我们将研究哪些干预措施最有帮助，并将 评估结果是否因种族而异。我们的中心假设是我们个性化的， 全面的PTB护理计划（UNC PTBCARE+）与压力减轻，与压力有关 PTB <35周的基因表达，同层负荷和速率。我们进一步假设UNC PTBCARE+ 由于种族主义相关的压力，最大的非白人患者会受益，并且生物学分析将提供关键 对与压力相关的PTB的基础机制的客观见解以及干预的影响。这 假设基于我们的初步数据，指示：（a）PTB高风险的UNC的孕妇 高压力和生活压力源（例如财务不安全，极端种族主义），（b）生物压力标记 包括基因转录水平因PTB状态而在妊娠中期血液中的状态有所不同，（c）患者的压力减轻 在NC队列中接受专业PTB产前护理。在我们先前的工作和其他工作的基础上，这令人兴奋 建议将确定UNC PTBCARE+程序的哪些方面对于与压力相关的PTB最重要 减少。我们通过以下目的检验我们的假设：目标1-评估UNC PTBCARE+的影响 关于PTB高风险的孕妇感知压力和韧性的计划；目标2-量化程度 UNC PTBCARE+程序与改善怀孕期间的生物应力度量有关； AIM 3-确定UNC PTBCARE+程序对PTB <35周的影响。这项研究提供 针对PTB的主要公共卫生问题的有形，个性化的解决方案，并带有巨大的解决方案 提供可普遍的低风险策略来减少PTB和PTB相关的差异。