The Role of Social Support as a Buffer Against Adverse Perinatal Outcomes Among Women Experiencing Discrimination and Neighborhood Deprivation

项目摘要 婴儿的不良出生结果影响整个生命过程中的健康， 抑郁症在很大程度上导致产妇发病和死亡。邻里剥夺和 歧视与这些不利的围产期结果及其差异有关，但很难 制定干预措施，限制这些有害的接触。研究表明，社会支持是一个可变的 这一特征可以缓冲产妇压力对某些分娩结果的不利影响，但 众所周知，它有可能缓冲邻里剥夺和歧视对围产期的影响， 结果。目的1将评估产前社会支持对邻里关系影响的修正程度 贫困对不良出生结果的影响，包括早产、低出生体重和小于胎龄儿。 目标2将检验产前社会支持对邻里剥夺效应的修正程度 关于先兆子痫目的3将探讨产后社会支持在多大程度上改变了 对产后抑郁症的歧视未产妊娠结局研究：监测母亲对 9，289例妊娠的Be多中心队列将用于目标1和2。在这个群体中， 贫困程度用地区贫困指数（ADI）衡量，社会支持用 多维度社会支持感量表（MSPSS）。社区和儿童健康网络 目标3将使用2，510例妊娠的多中心队列。在这个队列中，歧视是通过 采用日常歧视量表（EDS）、产后社会支持量表（MSF）和医学结局量表（MSF）进行评定 采用爱丁堡产后抑郁量表（Edinburgh Postnatal Depression Scale）对产后抑郁进行测量 产后1、6和12个月时的抑郁量表（EPDS）。假设是， 社区剥夺和对围产期结果的歧视将减少高血压妇女， 与社会支持感低的女性相比， 缓冲效应因种族群体和社会支持类型而异。我们的发现可以帮助我们了解 在产前护理中进行心理社会风险筛查，以帮助确定最有可能受益的孕妇 从资源，如支持团体，保险覆盖的导乐，和新的干预措施，开发了一个 对哪些类型的社会支持最有效以及对哪些结果最有效的微妙理解。的 计划的研究和培训目标将丰富申请人在先进的流行病学严格的培训 方法，心理社会流行病学，围产期健康差异，产前临床护理，以及提供 专业发展，为她过渡到博士后奖学金做准备。配备了强大的 指导团队和埃默里丰富的培训环境，这个奖学金将提供一个坚实的基础， 申请人的长期目标是领导一个独立的研究计划，重点是精神和 在更广泛的社会环境背景下，促进怀孕妇女的心理健康。

PROJECT SUMMARY Adverse birth outcomes in infants affect health over the life course, and preeclampsia and postpartum depression contribute significantly to maternal morbidity and mortality. Neighborhood deprivation and discrimination are associated with these adverse perinatal outcomes and their disparities, but it is difficult to develop interventions to limit these harmful exposures. Research suggests that social support is a modifiable characteristic that can buffer against the adverse effects of maternal stress on some birth outcomes, but less is known about its potential to buffer the effects of neighborhood deprivation and discrimination on perinatal outcomes. Aim 1 will evaluate the degree to which prenatal social support modifies the effect of neighborhood deprivation on adverse birth outcomes, including preterm birth, low birth weight, and small for gestational age. Aim 2 will examine the degree to which prenatal social support modifies the effect of neighborhood deprivation on preeclampsia. Aim 3 will investigate the degree to which postnatal social support modifies the effect of discrimination on postpartum depression. The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to- Be multi-site cohort of 9,289 pregnancies will be used for Aims 1 and 2. In this cohort, neighborhood deprivation was measured by the Area Deprivation Index (ADI) and social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). The Community and Child Health Network multi-site cohort of 2,510 pregnancies will be used for Aim 3. In this cohort, discrimination was measured by the Everyday Discrimination Scale (EDS), postnatal social support was measured by the Medical Outcomes Study (MOS) Social Support Scale, and postpartum depression was measured by the Edinburgh Postnatal Depression Scale (EPDS) at 1, 6, and 12 months postpartum. The hypothesis is that the adverse effects of neighborhood deprivation and discrimination on perinatal outcomes will be diminished among women with high perceived social support compared to women with low perceived social support and secondarily that this buffering effect will differ by racial group and by type of social support. Our findings could help inform the value of psychosocial risk screening in prenatal care to assist in identifying pregnant women most likely to benefit from resources such as support groups, insurance-covered doulas, and new interventions developed with a nuanced understanding of which types of social support are most effective and for which outcomes. The planned research and training goals will enrich the applicant’s rigorous training in advanced epidemiologic methods, psychosocial epidemiology, perinatal health disparities, and prenatal clinical care, as well as provide professional development in preparation for her transition to a postdoctoral fellowship. Equipped with a strong mentoring team and Emory’s rich training environment, this fellowship will provide a strong foundation for the applicant’s long-term goal of leading an independent research program that focuses on the mental and psychosocial health of women who enter pregnancy, within the context of their broader social environments.