Active Surveillance of Pregnancies Ending in Stillbirths in Arkansas

 描述(申请人提供)：全球每年发生320万例死产。在美国和其他发达国家，死产在很大程度上是一种研究不足的围产期结局，尽管它是最常见的不良妊娠结局之一，占所有围产期死亡的一半。2006年，美国可获得的最新数据显示，死产发生在 每1000名活产婴儿中有6.05人死亡，远远高于许多高收入国家和美国2020年健康人口目标5.6(每1000名活产婴儿+胎儿死亡)的胎儿死亡率。在美国以及大多数发达国家和发展中国家，死产的确认率很低。关于死产发生率的最新国家数据是2006年的，这凸显了目前在确定和监测这一重要的围产期结局方面基础设施不足。2005年，美国疾病控制和预防中心(CDC)探索了扩大现有两个州出生缺陷监测项目的可行性，这些试点研究的成功表明，扩大现有出生缺陷登记的现有方法用于死产监测是一种可行且成本效益高的死产监测方法。CDC宣布了一项新的倡议，这是对出生缺陷研究的补充，以评估怀孕暴露(BD-STEPS)研究，试点扩大出生缺陷预防和研究中心现有的州出生缺陷登记，以包括对没有出生缺陷的死产的监测，并进行试点研究，以调查死产的可改变的风险因素。阿肯色州中心的 长期目标是预防或显著减少出生缺陷和不良妊娠结局的发生。我们建议在阿肯色州实施一个以人口为基础的、积极的无出生缺陷死产监测系统；通过参与这项初步研究作为对以下方面的补充，确定新的可改变的妊娠暴露，以减少死产的发生 BD-STEPS；并通过利用增加CDC资金的机构和外部资金，支持从NBDPS和BD-STEPS参与者那里收集的生物样本的高通量基因组和表观基因组分析，发现导致死产的基因-环境相互作用。通过我们的研究，我们将在制定预防出生缺陷和死产的卫生战略方面发挥主导作用。

 DESCRIPTION (provided by applicant): Each year 3.2 million stillbirths occur globally. In the U.S. and other developed countries, stillbirths is a largely under-studied perinatal outcome despite being one of the most common adverse pregnancy outcomes, accounting for one-half of all perinatal deaths. In 2006, the most recent data available for the U.S., stillbirths occurred in 6.05 of every 1,000 live births plus fetal deaths, much higher than many high-income countries and the U.S. Healthy People 2020 Objective of 5.6 (per 1,000 live births + fetal deaths) for fetal mortality rates. Stillbirths are poorly ascertained in the United States and most developed and developing countries. The most recent national data available on stillbirth prevalence is from 2006 which underscores the insufficient infrastructure currently in place for ascertainment and monitoring of this important perinatal outcome. In 2005, the Centers for Disease Control and Prevention (CDC) explored the feasibility of expanding two existing state birth defects surveillance programs, and the success of these pilot studies demonstrated that expanding current methods of existing birth defects registries for stillbirth surveillance is a viable and cot-effective method for surveillance of stillbirths. CDC announced a new initiative, which is a supplement to the Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS) study, to pilot the expansion of existing state birth defects registries in the Centers for Birth Defects Prevention and Research to include surveillance of stillbirths without birth defects and to conduct pilot studies to investigate modifiable risk factors for stillbirths. The Arkansas Center's long-term goal is to prevent or significantly reduce the occurrence of birth defects and adverse pregnancy outcomes. We propose to implement a population-based, active surveillance system of stillbirths without birth defects in Arkansas; identify novel modifiable pregnancy exposures that decrease the occurrence of stillbirths by participating in this pilot study as a supplement to BD-STEPS; and discover gene- environment interactions that lead to stillbirths by supporting high-throughput genomic and epigenomic analyses of biological samples collected from NBDPS and BD-STEPS participants using institutional and extramural funds that augment CDC funding. Through our studies, we will maintain a leading role in establishing health strategies to prevent birth defects and stillbirths.