Biobehavioral Determinants of the Microbiome and Preterm Birth in Black Women

描述（由申请人提供）：本研究的目的是阐明控制非洲裔美国人（AA）妇女怀孕期间微生物组结构和动力学的生物行为决定因素，并调查微生物组组成是否与PTB相关。拟议的研究将有助于对PTB种族内风险的生物心理社会理解，提供与任何其他美国人群相比不成比例经历PTB的AA女性相关的重要风险和保护因素的见解。我们的研究与消除种族差异的框架一致，该框架认识到研究种族内潜在风险因素的重要性，这是至关重要的第一步，并且与国家护理研究所的目标一致，即促进和改善个人，家庭和社区的健康在各种临床环境和不同人群中的整个生命周期。该研究将前瞻性招募一个社会经济学上多样化的H 960妊娠AA女性队列，并对其进行分娩随访，在三个时间点收集数据：两次通过产前护理预约期间的直接参与者联系（妊娠10-14周和26-30周），一次通过审查分娩住院的医疗记录。使用巢式病例对照方法，我们将指定所有经历PTB的妇女（估计125例）为病例;将从分娩足月儿的妇女中选择相同数量的对照。使用这项研究设计，我们将：（1）表征怀孕早期和晚期的阴道，口腔和肠道微生物组;（2）检查与PTB相关的生物行为因素-包括生物指标和压力经历，营养状况和健康行为-是否影响微生物组的组成;（3）确定早期和/或晚期妊娠中阴道、口腔和肠道微生物组的组成是否与PTB相关;（4）调查症状模式是否与微生物学环境相关，微生物学环境增加AA妇女PTB的风险。这项研究的成功有几个因素支持。首先，我们聚集了临床医生和基础和翻译科学家的多学科合作，代表传染病，妇产科，营养，遗传学和表观遗传学，压力 生理学、流行病学和信息学，由一名护士科学家领导。其次，我们得到了亚特兰大临床和转化科学研究所（CTSA奖# NIH UL 1 TR 000454）的支持;埃默里大学护士科学家跨学科培训奖（T32 NR 012715），埃默里大学生殖和围产期流行病学奖学金奖，以及埃默里综合基因组学核心实验室。第三，亚特兰大是广泛SES的AA女性的家园，其中许多人由埃默里大学的附属分娩医院提供服务，使我们能够对不同的AA女性群体进行抽样，允许研究中的生物行为决定因素有足够的变化，以区分其对微生物组的独立和相互作用的影响，并最终对PTB的风险。

DESCRIPTION (provided by applicant): The goals of this study are to elucidate the bio behavioral determinants that govern the structure and dynamics of the microbiome of African American (AA) women during pregnancy and to investigate whether microbiome composition is associated with PTB. The proposed study will contribute to a bio psychosocial understanding of within-race risk for PTB, providing insight into important risk and protective factors relevant to AA women who disproportionately experience PTB compared to any other US population. Our research is consistent with frameworks for eliminating racial disparities, which recognize the importance of studying potential risk factors within-race as a vital first step, and is congruent with the National Institute of Nursing Research goal of promoting and improving the health of individuals, families, and communities across the lifespan in a variety of clinical settings and within diverse populations. The study will prospectively enroll a socioeconomically diverse cohort of H 960 pregnant AA women and follow them through delivery, collecting data at three time points: twice via direct participant contact during prenatal care appointments (at 10-14 and 26-30 weeks' gestation), and once via review of the medical records from the delivery hospitalization. Using a nested case-control approach, we will designate as cases all women who experience PTB (an estimated 125 cases); an equal number of controls will be selected from among those who deliver a term infant. Using this study design we will: (1) Characterize the vaginal, oral, and gut microbiome during early and later pregnancy; (2) Examine whether bio behavioral factors linked with PTB - including biological indicators and experiences of stress, nutritional status, and health behaviors - influence the composition of the microbiome; (3) Determine whether the composition of the vaginal, oral, and gut microbiome in early and/or later pregnancy is associated with PTB; and (4) Investigate whether symptom patterns are associated with microbiomic milieu that increase the risk of PTB among AA women. The success of this research is supported by several factors. First, we have assembled a multidisciplinary collaboration of clinicians and basic and translational scientists representing expertise in infectious disease, obstetrics-gynecology, nutrition, genetics and epigenetics, stress physiology, epidemiology and informatics under the leadership of a nurse-scientist. Second, we have the support of the Atlanta Clinical and Translational Science Institute (CTSA award # NIH UL1TR000454); Emory's Interdisciplinary Training for Nurse Scientists Award (T32 NR012715), Emory's Reproductive and Perinatal Epidemiology Fellowship Award, and the Emory Integrated Genomics Core Laboratory. Third, Atlanta is home to AA women of broad SES, many of whom are served by Emory's affiliated delivery hospitals, enabling us to sample a diverse group of AA women, allowing for sufficient variation in the bio behavioral determinants under study to distinguish their independent and interactive effects on the microbiome and, ultimately, on the risk of PTB.