Trans-generational Impact of Maternal Obesity and Diabetes on Health Disparities

描述（由申请人提供）：随着肥胖和糖尿病对育龄妇女的影响越来越大，了解它们对后代健康的公共卫生影响至关重要。如果肥胖和糖尿病的宫内环境在很大程度上促成了这些流行病，那么不仅这些流行病在所有人口中的流行率将继续增加，而且肥胖和糖尿病高流行率的人口将继续受到不成比例的影响，从而导致种族和族裔群体之间的健康差距不断扩大。黑人和西班牙裔女性是美国最大的两个少数群体，她们不仅比非西班牙裔白人女性在怀孕期间更容易肥胖和患糖尿病，而且她们的体脂分布不同，糖尿病更严重，心血管风险也高于非西班牙裔白人女性。尽管如此，相对较少的研究调查了肥胖和糖尿病患者宫内环境中潜在的种族/民族差异。南卡罗来纳州（SC）大部分是农村地区，位于美国东南部的中心，这个地区历史上一直受到肥胖、糖尿病和种族健康差异的困扰。我们建议在基于人群的SC中调查和描述妊娠期糖尿病和肥胖的流行病学以及相关的出生结局，并使用模拟模型来预测妊娠期孕产妇肥胖和糖尿病在人群水平上跨多代的潜在影响。响应RFA-MD-09-004题为“NCMHD对少数民族和服务不足人群的健康差异研究（R01）”，将使我们能够(1)检查孕产妇糖尿病和肥胖对SC母婴结局种族差异的影响；(2)研究子宫内环境作为糖尿病和肥胖对SC不同种族/民族婴儿结局的影响机制；(3)使用离散事件模拟模型预测怀孕期间母亲肥胖和糖尿病对美国黑人、非西班牙裔白人和西班牙裔后代患病率的影响。该研究的创新之处在于，团队领导由一名系统工程师和一名流行病学家组成，后者建议使用系统工程方法（模拟）进行超出流行病学研究可行范围的研究。我们假设的概念框架是，母亲的健康影响婴儿的健康，婴儿的健康反过来又决定了人口的健康，并随后影响下一代。目前研究不足的关键领域是这项研究的目标：产妇肥胖和糖尿病对人口一级婴儿健康的影响，以及在肥胖和糖尿病方面种族/民族健康差距可能扩大。

DESCRIPTION (provided by the applicant): As obesity and diabetes increasingly affect women of childbearing age, understanding their public health impact on offspring health is paramount. If the obese and diabetic intrauterine environments are substantially contributing to these epidemics, not only will their prevalence continue to increase across all populations, but populations with a high prevalence of obesity and diabetes will continue to be disproportionately affected, resulting in a perpetual widening of health disparities between racial and ethnic groups. Black and Hispanic women, members of the two largest minority groups in the U.S., are not only more likely to be obese and have diabetes during pregnancy than non-Hispanic white women, but their body fat is distributed differently, their diabetes is more severe, and they have higher cardiovascular risk than non-Hispanic white women. Despite this, relatively few studies have examined potential racial/ethnic differences in the obese and diabetic intrauterine environments. South Carolina (SC) is largely rural and centrally located in the Southeastern United States, an area of the country historically plagued by obesity, diabetes and racial health disparities. We propose to investigate and characterize the epidemiology of diabetes and obesity during pregnancy and related birth outcomes in SC, a population-based setting, and to use a simulation model to predict the potential impact of maternal obesity and diabetes during pregnancy at the population level across multiple generations. Responding to RFA-MD-09-004 entitled, "NCMHD Health Disparities Research on Minority and Underserved Populations (R01)" will enable us to (1) examine the impact of maternal diabetes and obesity on racial disparities in maternal and infant outcomes in SC, (2) examine the intrauterine environment as a mechanism through which diabetes and obesity differentially impact infant outcomes across racial/ethnic groups in SC and (3) use a discrete event simulation model to predict the impact of maternal obesity and diabetes during pregnancy on their prevalence in subsequent generations in blacks, non-Hispanic whites and Hispanics in the United States. The research is innovative in that the team leaders consist of a systems engineer and an epidemiologist who proposes to use a systems engineering approach (simulation) to conduct research that goes beyond what is feasible in epidemiologic studies. The conceptual framework for our hypotheses is that a mother's health impacts her infant's health which in turn defines the population's health and subsequently impacts the next generation. Critical areas currently understudied are targeted by the study: the effects of maternal obesity and diabetes on infant health at the population level and a potential widening of racial/ethnic health disparities with respect to obesity and diabetes.