Adverse Outcomes in Nulliparous Pregnancies: The Ohio Collaborative

描述（由申请人提供）：在美国，首次怀孕的妇女占分娩的40%。有些会出现并发症，如早产（PTB）、先兆子痫、胎儿生长受限和死胎，这对母亲和胎儿都有风险。如果没有预料到这些，如果干预不及时和/或不适当，围产期发病率和死亡率可能会加剧。尽管各种临床和生物学特征与产科并发症有关，但一些（种族/民族、社会经济地位、先前妊娠结局）一直与其中许多并发症有关。首次怀孕的妇女缺乏关于先前妊娠结局的关键知识，无法指导产科管理。目前迫切需要数据，以便为未生育妇女的产科护理提供信息，并确定适当的介入性试验候选人。预防首次妊娠并发症可通过避免手术分娩和其他不良后果影响后续妊娠。来自CASE-MetroHealth医学中心和俄亥俄州立大学的申请人Pis已经建立了产科研究记录，特别是专注于PTB，并与他人合作开展多中心观察性和介入性研究。两位Pis都指导了初级调查人员，并开发了能够为多中心无产妇女早产网络（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协作（OPQC）网络共享相互合作的历史。CASE和俄亥俄州立大学的研究人员在MFMU和OPQC网络研究的设计和实施方面发挥了领导作用，并参与并领导了这些小组成功所需的管理委员会。两个申请机构共享成功完成产科和新生儿护理的观察性和介入性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网络的建立将对无神经节并发症的预测和预防带来重要的认识。申请机构拥有必要的能力和基础设施来合作开展这些研究，这些研究将直接影响临床实践并为未来的研究提供信息。

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.