Doctoral Dissertation Improvement: The Impact of Globalization and Psychosocial Stress on Gestation Length and Pregnancy Outcomes on the Pacific Island of Tutuila

在西方国家进行的短期、回顾性、横断面研究发现了一种与压力事件有关的妊娠中断模式。自然流产、死产、低出生体重和早产的发生率都与产妇压力增加有关。然而，人们对非西方妇女社会地位的差异如何影响怀孕结果和由此产生的婴儿健康知之甚少。本研究旨在探讨社会地位和慢性心理压力对自然流产、妊娠期长短和新生儿体型的影响。这项纵向、前瞻性、生物文化研究测量了妇女在怀孕前、怀孕期间的社会心理压力，并以产后对其婴儿健康的跟踪调查结束。早期妊娠丢失将通过生育监测仪和基于尿液的妊娠试验来确定。将使用两个相互关联的心理社会压力指标，爱泼斯坦-巴尔病毒（EBV）抗体浓度和状态不一致，来评估压力对美属萨摩亚图图伊拉岛108名妇女妊娠结局的影响。从母亲怀孕前和整个怀孕过程中收集指尖干血斑，分析EBV和c反应蛋白水平（CRP）。CRP水平检测感染，然后用于控制EBV水平。结合访谈和母婴人体测量学，这些技术可以确定心理社会压力对怀孕各个阶段的影响，并评估母亲压力对婴儿健康结果的作用。这些数据提供了一个机会，以评估妊娠过程中心理社会压力的妊娠结局，以及有关妊娠中特定类型的心理社会压力的信息。这项研究的数据提供了对怀孕损失的深入了解，这是生殖中最不为人所知的部分。此外，联合pi还参与了图图伊拉的社区外展和女童和妇女教育项目。

Short-term, retrospective, cross-sectional studies set in western countries have discovered a pattern of pregnancy disruption associated with stressful events. Incidences of spontaneous abortions, stillbirths, low birth weights and premature delivery have all been quantitatively associated with increased maternal stress. Little is known, however, about how disparities in the social status of non-western women can impact pregnancy outcomes and resultant infant health. The objective of the proposed research is to determine the association of social status and chronic psychosocial stress on spontaneous abortion, gestation length and neonate body size. This longitudinal, prospective, biocultural study measures psychosocial stress in women prior to conception, through pregnancy and concludes with a postpartum follow-up on the health of their infants. Early pregnancy loss will be determined using fertility monitors and urine based pregnancy tests. Two interrelated indicators of psychosocial stress, Epstein-Barr virus (EBV) antibody concentration and status incongruence, will be used to assess the effects of stress on pregnancy outcomes of 108 women on the American Samoan island of Tutuila. Fingertip dried blood spots are collected from mothers prior to and throughout the course of their pregnancy and analyzed for EBV and C-reaction protein levels (CRP). CRP levels detect infection and are then used to control EBV levels. Combined with interviews and maternal and infant anthropometrics, these techniques make it possible to identify the impact of psychosocial stress on all stages of pregnancy and to assess the role of maternal stress on health outcomes of infants. These data provide an opportunity to assess pregnancy outcomes in terms of psychosocial stress over the course of gestation and information regarding a specific type of psychosocial stress on pregnancy. Data from this study provides insight into pregnancy loss, the least well understood component of reproduction. Additionally, the co-PI is participating in community outreach and education programs for girls and women in Tutuilla.