Prenatal Epigenetics: Trauma and Outcomes of Labor Dysfunction

项目总结

PROJECT SUMMARY The United States spends more on maternity care than any other high-income country yet has rising rates of severe maternal morbidity and mortality. Among other high-income countries, the U.S. ranks as the worst in maternal morbidity and mortality rates. Moreover, there are significant disparities in severe maternal morbidity and mortality, with Black pregnant people in the U.S. being more likely than white people to experience severe maternal morbidity and mortality. Pregnant Black people are also disproportionately impacted by cumulative life trauma, which is a life course social determinant of health (SDoH) strongly associated with poor perinatal outcomes. One largely unexplored link between trauma and poor pregnancy outcomes in Black birthing people is epigenetic changes in physiologic systems that are integral to both labor initiation and parturition and human response to trauma. Among these are the hypothalamic-pituitary-adrenal axis (HPA-axis), oxytocinergic system, and inflammatory response system function which have all been noted to have changes associated with trauma exposure and play a role in parturition. The purpose of this NRSA fellowship is to utilize an adapted allostatic load model to evaluate the effects of trauma on labor outcomes, through an epigenome wide association study of DNA methylation, and its subsequent association with labor outcomes. We will leverage biologic samples and survey data already being collected from two prospective cohorts (R011NR019254: PI Dr. Nicole Carlson and R01MH115174: PI Dr. Vasiliki Michopoulos) of Black pregnant people living in the same geographic area. We plan to evaluate if cumulative life trauma, as reported in early pregnancy, is associated with labor dysfunction, including long labor duration and unplanned cesarean section. We theorize that trauma- associated epigenetic changes may provide a missing link connecting Black pregnant people’s trauma exposure with labor outcomes, thus providing insight into ways to optimize perinatal care for this population to reduce racial inequities in labor outcomes. This project also includes a comprehensive training plan designed to prepare a nurse-midwife clinician to be an independent research scientist with expertise in epigenetics, trauma, and perinatal disparities research.