Chronic stress in pregnancy: Self-report, biomarkers, and birth outcomes

描述（由申请人提供）：慢性应激对免疫系统和炎症反应有不利影响，可能是早产和相关出生结果种族差异的重要原因。然而，在文献中，母亲压力和早产之间的联系一直不一致。一个原因可能是使用多种多样的调查、工具和仪器来测量怀孕期间自我报告的压力。利用项目反应理论（IRT）模型，我们建议开发一个单一的，全面的，有效的量表来衡量怀孕期间自我报告的压力-或“优化”怀孕压力量表。该量表将根据2006名妇女对妊娠、感染和营养（PIN）研究数据库中多项自我报告的压力调查的反应得出。具体来说，IRT根据每个项目在概念连续统上的位置（例如，压力严重程度）及其在这个连续统上区分个体的能力来描述每个项目的特征。有了这些项目级别的数据，就可以为优化的量表确定最佳项目。我们建议评估自我报告的压力之间的关联，通过优化妊娠压力量表和CRH和皮质醇水平测量，以及PIN研究中女性自我报告和早产之间的关联。一个优化的怀孕期间自我报告的压力量表对未来的研究至关重要，以便能够检验自我报告的压力、压力的生物标记物和早产之间的因果关系。如果慢性产妇压力可以预测早产，那么优化的妊娠压力量表可以作为高危孕妇的筛查工具和治疗策略的评估工具，以减轻妊娠期间的压力，减少早产和早产的差异。

DESCRIPTION (provided by applicant): Chronic stress, with adverse effects on the immune system and on inflammatory response, may be an important cause of preterm birth and associated racial disparities in birth outcomes. However, an association between maternal stress and preterm birth has been inconsistently reported in the literature. One reason may be the use of multiple and varied surveys, tools, and instruments to measure self-reported stress in pregnancy. Using item response theory (IRT) modeling, we propose to develop a single, comprehensive, validated scale to measure self- reported stress in pregnancy - or an "optimized" stress in pregnancy scale. The scale will be derived from the responses of 2,006 women to multiple self-reported stress surveys in the Pregnancy, Infection and Nutrition (PIN) Study database. Specifically, IRT characterizes each item according to its location on the concept's continuum (e.g., stress severity) and its ability to discriminate individuals along this continuum. Having this item-level data permits the identification of the best items for an optimized scale. We propose to evaluate the association between self-reported stress, measured by the optimized stress in pregnancy scale and CRH and cortisol levels and between self-reported and preterm birth in women in the PIN Study. An optimized scale of self-reported stress in pregnancy is essential for future studies to be able to examine causal relationships between self-reported stress, biologic markers of stress, and preterm birth. If chronic maternal stress can be shown to be predictive of preterm birth, an optimized stress in pregnancy scale could serve as a screening tool of high-risk pregnant women and as an evaluation tool of treatment strategies to mitigate stress during pregnancy and to reduce preterm delivery and disparities in preterm birth. PUBLIC HEALTH RELEVANCE: The goal of the proposed research is to create a more efficient and effective scale to measure self-reported stress in pregnancy by applying Item Response Theory modeling to the responses to multiple stress surveys already collected from 2,006 pregnant women in the Pregnancy, Infection and Nutrition (PIN) Study and, then, to investigate associations between self-reported stress, measured by the optimized stress scale, and stress biomarkers and preterm birth for women in the PIN Study. If chronic maternal stress can be shown to be predictive of preterm birth, then an optimized stress in pregnancy scale could serve as a screening tool of high-risk pregnant women and as an evaluation tool of treatment strategies to mitigate stress during pregnancy and to reduce preterm delivery and disparities in preterm birth.