Personalized care for prenatal stress reduction and preterm birth prevention

项目摘要 该项目解决了早产(PTB)解决方案的关键障碍，部署了 一种新颖、个性化、全面的三级结核病预防计划(UNC PTBCARE+)，以减少 围产期压力。肺结核存在显著差异；黑人孕妇分娩的可能性高出49% 早产，早产时患肺结核的风险更高，感觉到的压力更大，而且有更高的 与其他种族患者的异静负荷比较。UNC PTBCARE+解决压力和相关机制 结核病的基础。我们的长期目标是完善和广泛部署循证干预措施 减轻孕期压力，减少肺结核。目的是在一项随机对照试验中测试 将招募1,509名孕妇，无论我们的UNC PTBCARE+计划是否提供特定压力 减少工具包和一名肺结核护理协调员(第1级，所有患者随机加入UNC PTBCARE+)，增强版 心理社会支持(2a级支持，随机筛选阳性患者的子集)，财务 支持(第2b级支持，随机筛选为阳性的患者子集)，或两者兼而有之(第3级 支持)与减轻压力有关(主观上由经过验证的调查评估，客观上由 生物标志物)，以及PTB&lt；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，在我们的个性化， 全面的肺结核护理计划(UNC PTBCARE+)与减少压力有关，与压力有关 基因表达、异位负荷和35周的肺结核发生率。我们进一步假设UNC PTBCARE+ 由于种族主义相关的压力，非白人患者将受益最大，生物分析将提供关键 目的了解应激相关肺结核的发病机制及干预效果。这 假设是基于我们的初步数据表明：(A)北卡罗来纳大学患有肺结核的高危孕妇有 高应激率和生活应激源(例如，经济不安全、极端种族主义)，(B)生物应激标志 包括妊娠中期血液中结核病状态的不同基因转录水平，(C)患者之间的压力减轻 在NC队列中接受专门的肺结核产前护理。在我们和其他人之前工作的基础上，这是令人兴奋的 建议书将确定UNC PTBCARE+计划的哪些方面对压力相关的PTB最关键 还原。我们通过以下目标验证我们的假设：目标1-评估UNC PTBCARE+的效果 结核病高危孕妇感受到的压力和恢复力计划；目标2-量化程度 UNC PTBCARE+计划与改善怀孕期间的生物应激措施有关； 目的3-确定UNC PTBCARE+计划对PTB和35周的影响。这项研究提供 为结核病的主要公共卫生问题提供切实、个性化的解决方案，并带来巨大的 有可能提供可推广的低风险战略，以减少肺结核和肺结核相关的差异。

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.