Evaluation and validation of a novel instrument to assess the psychosocial and drug history backgrounds of pregnant women with or without Opioid Use Disorder

摘要 新冠肺炎大流行提供了一个前所未有的机会，可以进行前瞻性、纵向 调查影响健康的社会决定因素，包括结构性种族主义和 歧视(SRD)、产妇压力对产妇身心健康的影响。石溪 新冠肺炎怀孕经历(SB-COPE)研究，这是拟议项目的基础， 包括来自7400多名刚开始怀孕的人的详细的前瞻性心理社会数据 新冠肺炎大流行(n=4,400)或美国第二次新冠肺炎激增(n=3,000)，包括1,400 有色人种。这项紧迫的竞争性修订提案的主要目标是前瞻性地 确定与流行病相关的对母亲压力的影响，确定与这些相关的SDoH机制 影响，并调查压力对孕产妇发病率和围产儿结局的影响。这项建议 寻求将SB-COPE研究队列的评估延长一年，并跟踪参与者 直到产后第一年，包括对一些人来说，到他们的下一次怀孕。拟议的项目将：目标1) 找出在大流行期间造成产妇压力的因素。据推测，孕妇 受SDoH影响，包括SRD在内，由于大流行，将经历更多压力。SDoH将成为 在大流行背景下调查的情况包括地理差异、种族/族裔、关系和经济 身份，性和性别认同。SRD的因素包括每天的产前性别歧视 歧视，以及医疗保健领域的歧视。压力因素包括全球感知的压力、流行病- 相关压力、特定于妊娠的压力和应激性生活事件。目标2)确定产前的贡献者 以及大流行期间的产后心理健康发病率。压力较大的人有 假设报告了更高的心理健康发病率(抑郁、焦虑和强迫症 症状)产前和产后。应激类型的不同影响(例如，与大流行有关 压力、应激性生活事件)以及压力、SDoH和SRD之间的交互作用(包括医疗保健途径和 (质量)在预测心理健康结果方面的作用将得到检验。目标3)确定导致较差的途径 在大流行期间，产妇的身体健康和不良的围产期结局。据推测， SDoH将预测不良围产儿结局的可能性更大(例如，低出生体重、早产； 紧急交付)。据预测，这种联系是由产前母体压力、母体健康 行为，以及医疗服务的可及性和质量。这个计时严格的项目充分利用了现有的、广泛的 基线数据集(包括NIH公共数据元素)，大型SB-COPE研究队列在怀孕期间 关键大流行时期，包括相当数量的有色人种，以及具有高度相关性的 一个多学科的研究团队，严格识别SDoH、SRD，并解释它们与压力相关的影响 在新冠肺炎大流行背景下的孕妇。

Abstract The COVID-19 pandemic provides an unprecedented opportunity to conduct prospective, longitudinal investigation of the effects of Social Determinants of Health (SDoH), including Structural Racism and Discrimination (SRD), and maternal stress on maternal physical and mental health morbidity. The Stony Brook COVID-19 Pregnancy Experiences (SB-COPE) Study, which forms the foundation for the proposed project, includes detailed prospective psychosocial data from over 7,400 persons who were pregnant at the beginning of the COVID-19 pandemic (n=4,400) or at the second U.S. COVID-19 surge (n=3,000), including 1,400 persons of color. The main objectives of this Urgent Competitive Revision proposal are to prospectively determine pandemic-related impacts on maternal stress, identify SDoH mechanisms associated with these impacts, and investigate the effects of stress on maternal morbidity and perinatal outcomes. The proposal seeks to extend assessment of the SB-COPE Study cohort for an additional year, and to follow participants into the first year postpartum, including, for some, into their next pregnancy. The proposed project will: Aim 1) Identify contributors to maternal stress during the pandemic. It is hypothesized that pregnant persons affected by SDoH, including SRD, will experience more stress as a result of the pandemic. SDoH to be investigated in the pandemic context include geographical disparities, race/ethnicity, relationship and economic status, and sexual and gender identity. SRD factors include prenatal gendered racism, everyday discrimination, and discrimination in healthcare. Stress factors include global perceived stress, pandemic- related stress, pregnancy-specific stress, and stressful life events. Aim 2) Identify contributors to prenatal and postpartum mental health morbidities during the pandemic. Persons with higher levels of stress are hypothesized to report greater mental health morbidities (depression, anxiety, and obsessive-compulsive symptoms) prenatally and in the postpartum period. Differential effects of stress types (e.g., pandemic-related stress, stressful life events) and interactions among stress, SDoH, and SRD (including healthcare access and quality) in predicting mental health outcomes will be examined. Aim 3) Identify pathways resulting in poorer maternal physical health and adverse perinatal outcomes during the pandemic. It is hypothesized that SDoH will predict greater likelihood of adverse perinatal outcomes (e.g., low birthweight, preterm birth; emergency delivery). This association is predicted to be mediated by prenatal maternal stress, maternal health behaviors, and healthcare access and quality. This critically timed project capitalizes on an existing, extensive baseline dataset (including NIH common data elements), large SB-COPE Study cohorts pregnant during critical pandemic periods, including a sizeable number of persons of color, and the highly relevant expertise of a multidisciplinary research team to rigorously identify SDoH, SRD, and explain their stress-related effects on pregnant persons in the context of the COVID-19 pandemic.