Mechanisms for Racial Disparity in Preterm Birth

描述（由申请人提供）：我们提出了一个五年的人口为基础的 前瞻性队列研究，以评估早产的相对贡献 出生时生殖道感染10例，母亲压力和遗传 非裔美国人和白色人免疫反应增强的倾向 居住在华盛顿金郡的女性。潜在的主题将是 通过出生证数据查明的，并采取适当措施， 保护机密。我们将招募100名非裔美国人和100名白色人 妊娠20-34周时有早期早产史的女性， 100名非洲裔美国人和100名白色妇女的对照组， 出生时间>36周初步评估将至少进行6个月 首次分娩后，将包括阴道植物群评价， 产妇压力的定性和定量测量， 牙周炎和细胞因子产生的遗传变异性。我们将提供 参与者治疗或转诊任何可改变的早产风险因素 在初步评估中确定的出生。我们随后将 受试者前瞻性地并预计30-40%的队列将有 随访期间再次妊娠。再次怀孕的妇女将 提供阴道植物群、宫颈长度和母体压力的评估 因可改变的风险因素而接受治疗或转诊。成果 第二次怀孕将得到确认。这项研究设计将使我们能够 审查以下具体目标：1。研究抗原性增加的作用 下生殖道感染的刺激是 非裔美国人和 白色女人。2.检查产妇压力与炎症的相关性 唤醒，按种族和既往妊娠史分层。3.评估母体 和胎儿基因对促炎反应的贡献， 这些早产和新生儿的结果。结合起来，这些 相互关联的目标将解决最合理的机制， 美国妇女继续至少是白色妇女的两倍， 过早分娩。我们还计划探索遗传学和 易感性，母亲压力，炎症性唤起，下生殖道 感染和早产。我们假设有不止一个的女性 诱发因素明显增加早产的风险， 非洲裔美国妇女比白色妇女更有可能有多个 诱发因素我们希望这些研究最终能导致 制定更有效的策略来预防早产并 减少早产、低出生体重和婴儿死亡率方面的差距 黑人和白色女性之间的差异

DESCRIPTION (provided by applicant): We propose a five year population-based prospective cohort study to evaluate the relative contributions to pre term birth of 10 genital tract infection, maternal stress and a genetic predisposition to an enhanced immune response among African American and white women resident in King County, Washington. Potential subjects will be identified through birth certificate data, with appropriate measures to protect confidentiality. We will enroll 100 African American and 100 white women with a prior early preterm birth at 20-34 weeks gestation and a comparison group of 100 African American and 100 white women with prior term birth at >36 weeks. The initial assessment will be performed at least 6 months after the index delivery and will include evaluation of vaginal flora and endometritis, maternal stress by qualitative and quantitative measures, periodontitis, and genetic variability in cytokine production. We will offer participants treatment or referral for any modifiable risk factors for preterm birth that are identified in the initial evaluation. We will then follow subjects prospectively and anticipate that 30-40% of the cohort will have a subsequent pregnancy during follow-up. Women with a subsequent pregnancy will be offered evaluation of vaginal flora, cervical length, and maternal stress with treatment or referral offered for modifiable risk factors. Outcomes for second pregnancies will be ascertained. This study design will allow us to examine the following specific aims: 1. Study the role of increased antigenic stimulation from lower genital tract infection as a determinant of endometritis, chorioamnionitis and preterm birth among African American and white women. 2. Examine the correlation of maternal stress with inflammatory arousal, stratified by race and prior pregnancy history. 3. Assess maternal and fetal genetic contributions to the pro-inflammatory response and correlate these with preterm birth and neonatal outcome. In combination, these inter-related aims will address the most plausible mechanisms by which African American women continue to be at least twice as likely as white women to deliver prematurely. We also plan to explore the synergy between genetic predisposition, maternal stress, inflammatory arousal, lower genital tract infection, and preterm birth. We hypothesize that women with more than one predisposing factor are at a markedly increased risk for preterm birth, and that African American women are more likely than white women to have multiple predisposing factors. We hope that these studies may eventually lead to the development of more effective strategies to prevent preterm birth and to reduce the disparity in preterm birth, low birthweight and infant mortality between African American and white women.