Psychoneuroimmunology: Preterm birth in Hispanics

描述(申请人提供)：西班牙裔人口是美国增长最快的少数民族，具有高生育率和高早产率(PTB)的潜力。如果肺结核发病率继续上升，将对儿童造成毁灭性影响，并增加医疗成本。在R01 NR00789-04的更新应用中，我们建议澄清西班牙裔妇女的文化适应对肺结核的影响，并评估心理社会、生理和遗传中介因素在文化适应与出生结局之间的关系中的作用。当个体接受另一种文化的态度、价值观、习俗、信仰和行为时，就会发生文化适应。此前的研究表明，这是一个拉美裔悖论，即尽管社会经济地位较低，但社会关系完好无损、文化适应程度相对较低的拉美裔人的健康状况好于预期。我们目前的研究支持这一点，并指出文化适应程度较高的女性早产率为13.4%，而文化适应程度较低的女性肺结核发病率仅为4.7%。在文化适应程度较高的人群中，应激产生的炎症因子更高，潜在地增加了肺结核的风险。有了新的资金，我们将通过研究怀孕22-24周的西班牙裔孕妇来检查这些结果。目的1：确定哪些文化适应因素可以预测与肺结核和LBW相关的免疫和内分泌反应。目的2：确定文化适应因素对预测肺结核和LBW的免疫和内分泌反应的影响，以确定文化适应痛苦的哪些成分。目的3：确定心理社会保护因素中的哪些成分介导了文化适应因素对预测肺结核和LBW的免疫和内分泌反应的贡献。目的4：确定可能影响肿瘤坏死因子-1和白介素1ra的促炎细胞因子基因多态性，并可能介导应激反应。这项前瞻性的观察性研究将聚焦于500名西班牙裔妇女，年龄在14-45岁，只有一次宫内妊娠。我们将：1)使用自我报告工具评估文化适应困境和心理社会保护因素；2)多维测量文化适应；3)测量血液中大量的应激和生殖激素、炎性细胞因子及其基因多态性；4)通过回顾病历评估母婴结局；5)通过Logistic回归和/或结构方程模型分析数据。我们将学习文化适应如何影响生物反应。我们计划使用心理社会和生物风险数据来集中干预那些风险最高的女性。公共卫生相关性：这次更新的目的是澄清西班牙裔妇女的文化适应对早产的影响，使用文化适应的多维衡量标准，并评估中介因素在解释文化适应与生育结果之间的关系中的作用。我们还将检验我们目前的证据是否与更多的文化适应(英语熟练程度)有关的炎症增加与炎症反应的遗传易感性(即增加早产风险)有关。在实施促进母婴健康结局的干预措施的过程中，我们对文化适应和早产之间的关系的理解至关重要。

DESCRIPTION (provided by applicant): The Hispanic population, the fastest growing ethnic minority in the US, has a high fertility rate and the potential for a high rate of preterm births (PTB). If the PTB rate continues to rise, it will have devastating effects on children and increase medical costs. In this renewal application of R01 NR00789-04, we propose to clarify the impact of acculturation of Hispanic women on PTB, and to assess the roles of psychosocial, physiologic, and genetic mediating factors in the relationships between acculturation and birth outcomes. Acculturation occurs as individuals adopt the attitudes, values, customs, beliefs and behaviors of another culture. Previous studies show a Hispanic Paradox in which relatively less acculturated Hispanics with intact social relationships exhibit better than expected health outcomes, despite low socio- economic status. Our current study supports this and indicates a preterm birth rate of 13.4 percent for the more acculturated women as compared to a PTB rate of only 4.7 percent for the less acculturated women. Inflammatory factors resulting from stress are higher in our more acculturated group, potentially increasing the risk of PTB. With renewed funding, we will examine these results by studying Hispanic pregnant women at 22-24 weeks gestation. Aim 1: Identify which acculturation factors predict immune and endocrine responses that are associated with PTB and LBW. Aim 2: Identify which components of acculturative distress mediate the contribution of acculturation factors on the immune and endocrine responses that predict PTB and LBW. Aim 3: Identify which components of the psychosocial protective factors mediate the contribution of acculturation factors to immune and endocrine responses that predict PTB and LBW. Aim 4: Identify pro-inflammatory cytokine gene polymorphisms that may affect TNF-1 and IL-1Ra and may mediate stress responses. This prospective, observational study will focus on 500 Hispanic women, ages 14-45 years, with a single intrauterine pregnancy. We will: 1) use self-report instruments to assess acculturative distress and psychosocial protective factors; 2) measure acculturation in a multi-dimensional way; 3) measure numerous stress and reproductive hormones, and inflammatory cytokines in the blood and their gene polymorphisms; 4) assess maternal and infant outcomes through a review of medical records; 5) analyze data through logistic regression and/or structural equation modeling. We will learn how acculturation affects biological responses. We plan to use psychosocial and biological risk data to focus interventions for those women most at risk. PUBLIC HEALTH RELEVANCE: The purpose of this renewal is to clarify the impact of acculturation of Hispanic women on preterm birth, using a multidimensional measure of acculturation and assessing the role of mediating factors in explaining the relationships between acculturation and birth outcomes. We will also examine whether our current evidence related to increased inflammation with more acculturation (English proficiency) is different by genetic predisposition of the inflammatory response (i.e. increasing the risk of preterm birth). Our understanding of the relation between acculturation and prematurity is vital in the process of implementing interventions to promote a healthy maternal and fetal outcome.