Cesarean delivery in overweight and obese women: patient and systems factors

描述（由申请人提供）：K99/R00奖将提供必要的保健服务研究和临床产科实践培训，使候选人成为一名专注于生殖健康差异的独立跨学科研究人员。在美国，剖宫产率已达到流行病的程度。超重和肥胖妇女剖宫产的风险增加，剖宫产后的短期和长期发病率也增加。然而，对于如何为超重/肥胖妇女提供最佳的产科护理，以最大限度地提高她们成功实现阴道分娩的机会，人们知之甚少。患者和系统层面的因素是分娩方式的重要决定因素。在剖宫产中存在种族/民族差异，肥胖和种族的相对贡献尚不清楚。此外，我们对产程繁忙（高产程）天数对剖宫产率的影响知之甚少。该项目旨在理清肥胖和种族/民族的影响，并确定每日产生量对剖宫产的影响。拟议的K99/R00研究将使用包含不同出生人口（加利福尼亚）的大型管理数据集来梳理肥胖和种族/民族对分娩方式的影响，探索效果修改的可能性。这种类型的相互作用已被观察到肥胖和种族对其他产科结果的影响。K99阶段将允许候选人制定每日产科量的度量，或在给定的一天有多忙的劳动和分娩单位。在R00阶段，候选人将分析高容量天数对无产、足月、单胎、顶点剖宫产率的影响。还将在超重/肥胖人群和少数种族妇女的亚组中进行分析，以了解产科护理过程的改变是否会对其结果产生不同的影响。这些创新的分析和方法将提供急需的非医学预测因素的剖宫产妇女在最大风险的不良妊娠结局。俄勒冈健康与科学大学是开展这项培训和研究的理想场所，因为它在临床产科、产科结果研究和卫生服务研究方面处于领先地位。候选人还将利用俄勒冈临床和转化研究所的资源，促进专业发展，并促进向研究独立的过渡。

DESCRIPTION (provided by applicant): This K99/R00 Award will provide the training in health services research and clinical obstetric practice needed to develop the candidate into an independent interdisciplinary researcher focusing on reproductive health disparities. The rate of cesarean delivery has reached epidemic proportions in the U.S. Overweight and obese women are at increased risk of cesarean, as well as short-term and long-term morbidities subsequent to cesarean delivery. However, very little is known about how to optimally provide obstetric care to overweight/obese women, to maximize their chance of successfully achieving a vaginal delivery. Patient- and systems-level factors are important determinants of mode of delivery. There are racial/ethnic disparities in cesarean delivery, and the relative contribution of obesity and race i unknown. Additionally, very little is known about the effect of busy (high-volume) days in Labor & Delivery on cesarean delivery rates. This project aims to disentangle the effects of obesity and race/ethnicity, and establish the impact of daily obstetric volume, on cesarean delivery. The proposed K99/R00 study will use a large administrative dataset containing a diverse population of births (California) to tease out the impact of obesity and race/ethnicity on mode of delivery, exploring the possibility of effect modification. Interaction of this type has been observed for obesity and race effects on other obstetric outcomes. The K99 phase will allow the candidate to develop a metric of daily obstetric volume, or how busy a Labor & Delivery unit is on a given day. In the R00 phase, the candidate will analyze the impact of high-volume days on the nulliparous, term, singleton, vertex cesarean delivery rate. Analyses will also be conducted within the overweight/obese populations and among subgroups of racial minority women, to see if altered processes of obstetric care affect their outcomes differentially. These innovative analyses and methodologies will provide much-needed information on non-medical predictors of cesarean delivery among women at the greatest risk of adverse pregnancy outcomes. Oregon Health and Science University is the ideal setting to conduct this training and research, because of its leadership in clinical obstetrics, obstetric outcomes research, and health services research. The candidate will also leverage the resources at the Oregon Clinical and Translational Research Institute to foster professional development and facilitate the transition to research independence.