Adverse Outcomes in Nulliparous Pregnancies: The Ohio Collaborative

未产妊娠的不良后果：俄亥俄州合作组织

• 批准号: 7791631
• 负责人: BRIAN M. MERCER
• 金额: $ 21.55万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-01-10 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7791631
• 关键词: Biologic Characteristic; Biological Markers; Caregivers; Caring; Clinical; Clinical Research; Clinical and Translational Science Awards; Collaborations; Data; Discipline of obstetrics; Doppler velocimetry; Environment; Epigenetic Process; Ethnic Origin; Faculty; Fetal Growth Retardation; Fetus; Funding; Future; Genomics; Hospitals; Human Resources; Image; Institution; Intervention; Knowledge; Leadership; Link; Medical center; Mentors; Monitor; Morbidity - disease rate; Mothers; Multicenter Trials; National Institute of Child Health and Human Development; Neonatal; Neonatology; Observational Study; Ohio; Pathology; Patient Care; Patients; Performance; Perinatal; Perinatal Epidemiology; Physiological; Population; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Prevention; Principal Investigator; Procedures; Process; Proteomics; Publications; Race; Recording of previous events; Records; Research; Research Infrastructure; Research Personnel; Research Subject Recruitments; Resources; Risk; Sampling; Science; Site; Socioeconomic Status; Specialist; Translational Research; Ultrasonography; United States; Universities; Woman; adverse outcome; clinical practice; design; experience; fetal; fetal medicine; follow-up; genetic epidemiology; high risk; interest; mortality; multidisciplinary; prevent; public health relevance; sample collection; stillbirth; success

DESCRIPTION (provided by applicant): Women in their first pregnancy constitute ~40% of deliveries in the United States. Some will suffer complications such as preterm birth (PTB), preeclampsia, fetal growth restriction and stillbirth, which carry risks for both mother and fetus. The resultant perinatal morbidities and mortality can be exacerbated if these are not anticipated and If intervention Is not timely and/or appropriate. Though various clinical and biological characteristics have been linked to obstetric complications, several (race/ethnicity, socioeconomic status, prior pregnancy outcomes) have been consistently associated with many of these. Women in their first pregnancy lack crucial knowledge regarding prior pregnancy outcomes to guide obstetric management. Data to inform obstetric care of nulliparous women, and to identify appropriate candidates for interventional trials, are critically needed. Prevention of complications in the first pregnancy could impact subsequent gestations through avoidance of operative delivery and other adverse outcomes. The applicant Pis from CASE-MetroHealth Medical Center and Ohio State University have established records for obstetric research, especially which focused on PTB, and have collaborated together and with others in the conduct of multicenter observational and interventional studies. Both Pis have mentored junior investigators and developed research teams capable of contributing to the research planned in the multicenter Preterm Birth in Nulliparous Women network (The PBN Network). The applicant institutions share a history of mutual collaboration through the NICHD Maternal-Fetal Medicine Units (MFMU), and the Ohio Perinatal Quality Collaborative (OPQC) networks. The CASE and Ohio State University investigators have provided leadership in design and conduct of MFMU and OPQC network studies, and have participated in and led the administrative committees needed for the success of these groups. Both applicant institutions share the culture and resources needed to successfully complete observational and interventional studies in obstetric and neonatal care. We offer resources and expertise in fetal imaging, Doppler velocimetry, perinatal pathology, genetics and epidemiology. The PBN Network will bring important understanding to the prediction and prevention of complications in nulliparas. The applicant institutions possess the needed abilities and infrastructure to collaborate in the conduct of these studies that will directly impact clinical practice and inform future research. PUBLIC HEALTH RELEVANCE: First pregnancies represent approximately 40% of deliveries, and result in ~1.6 million deliveries annually in the United States. In nulliparous women, the risk of complications is difficult to determine due to the lack of information from prior pregnancies. This study will provide to caregivers, the clinical, ultrasound, patho- physiologic and biologic markers needed identify those at-risk for pregnancy complications including preterm birth, so that monitoring and interventions can be focused to prevent or reduce the impact of these, and to identify at-risk women who can be included in future interventional trials.

描述（由申请人提供）：在美国，第一次怀孕的妇女占分娩的40%。有些人会遭受并发症，如早产（PTB），先兆子痫，胎儿生长受限和死产，这对母亲和胎儿都有风险。如果没有预料到这些情况，如果干预不及时和/或不适当，那么由此产生的围产期发病率和死亡率可能会加剧。虽然各种临床和生物学特征与产科并发症有关，但其中一些（种族/民族，社会经济地位，既往妊娠结局）一直与其中许多相关。第一次怀孕的妇女缺乏关于以前怀孕结果的重要知识，无法指导产科管理。目前迫切需要提供数据，为未经产妇女提供产科护理信息，并确定进行干预性试验的适当候选人。预防第一次怀孕的并发症可以通过避免手术分娩和其他不良后果来影响随后的怀孕。 来自CASE-MetroHealth医学中心和俄亥俄州州立大学的申请人Pis已经建立了产科研究记录，特别是关注PTB的研究，并在多中心观察性和干预性研究中与他人合作。两位Pis都指导了初级研究人员，并建立了能够为多中心未产妇早产网络（PBN网络）计划的研究做出贡献的研究团队。申请机构通过NICHD母胎医学单位（MFMU）和俄亥俄州围产期质量合作（OPQC）网络共享相互合作的历史。CASE和俄亥俄州州立大学的研究人员在MFMU和OPQC网络研究的设计和实施中发挥了领导作用，并参与和领导了这些小组成功所需的行政委员会。两个申请机构共享成功完成产科和新生儿护理观察和干预研究所需的文化和资源。我们提供胎儿成像、多普勒测速、围产期病理学、遗传学和流行病学方面的资源和专业知识。 PBN网络将为预测和预防初产妇并发症带来重要的理解。申请机构拥有合作开展这些研究所需的能力和基础设施，这些研究将直接影响临床实践并为未来研究提供信息。 公共卫生关系：第一次怀孕约占分娩的40%，在美国每年约有160万例分娩。在未经产的妇女中，由于缺乏以前怀孕的信息，很难确定并发症的风险。本研究将为护理人员提供识别妊娠并发症（包括早产）风险所需的临床、超声、病理生理学和生物学标志物，以便监测和干预措施能够集中于预防或减少这些影响，并识别可纳入未来干预性试验的高危女性。