Maternal Postpartum Symptom Profiles and Associated Social Determinants of Health

摘要。美国每年有380万妇女分娩。很多产后妈妈 经历一系列产后症状，如睡眠障碍和产后抑郁症， 与产后体重保持和长期体重增加有关，增加了心血管风险 在生命历程中。因此，产后症状及其影响影响母亲的整体健康和质量， 生活产后症状常同时出现，且相互关联，称为症状 集群与单独表现的症状相比，症状群更难管理， 导致更糟糕的健康结果。以前的研究集中在个别症状的严重程度或 这限制了我们对产后症状群如何表现和影响健康的理解。 此外，在先前的研究中缺乏种族-民族多样性，这在理解种族多样性方面造成了严重的差距。 美国产妇健康的差距。这项研究将使用来自联邦政府资助的研究，社区儿童 健康网络，并将包括940名黑人和408名西班牙裔母亲（76%的样本）。其目的是： 目标1。使用潜伏期识别产后6个月时具有不同症状特征的母亲亚组 剖面分析这种方法将允许识别具有相似症状严重程度的母亲亚组 经验（档案）和那些谁是在风险更严重的症状经验，使个性化 可以制定干预措施。目标2.检查个人、关系和社区层面的社会 健康决定因素（SDOH）与每个症状特征相关。这将提供重要的知识 哪些SDOH影响产后症状。目标3。研究非稳态 负载和每个症状配置文件。非稳态负荷是累积的生理磨损和撕裂的标志， 对心血管和代谢健康的后续影响（例如，肥胖），这有助于产妇 死亡率和发病率。然而，非稳态负荷和产后症状之间的关系是 未知因此，研究这种关系将为产后的健康风险提供新的见解。 这将有助于新的有针对性的干预战略。这项研究与国家 护理研究所的战略计划，以促进个性化的症状管理和特殊 在SDOH利益优先。研究结果将提供重要的知识，可以促进我们对 产后症状概况和SDOH，为未来的研究提供信息。培训：导师团队， 实质性和方法学专业知识将支持申请人的培训，以成功地进行研究 为她将来成为一名护士科学家做准备以下培训目标是获得和扩展 了解：（1）复杂产后症状经历和SDOH;（2）先进的定量方法 用于表征产后症状概况;（3）症状科学研究中使用的方法， 大数据分析;（4）干预开发，以改善产后症状体验。

ABSTRACT. Annually 3.8 million women give birth in the United States (US). Many postpartum mothers experience an array of postpartum symptoms, such as sleep disturbance and postpartum depression, which have been linked to postpartum weight retention and long-term weight gain, increasing the cardiovascular risks over the life course. Thus, postpartum symptoms and their effects impact mothers’ overall health and quality of life. Postpartum symptoms often co-occur and are correlated to each other, which is referred to as symptom clusters. Compared to an individually manifested symptom, symptom clusters are more difficult to manage and contribute to worse health outcomes. Previous research has focused on either individual symptom severity or occurrence, which limits our understanding of how postpartum symptom clusters manifest and impact health. In addition, a lack of racial-ethnic diversity in prior research creates a critical gap in understanding the racial disparities in US maternal health. This study will use data from a federally-funded study, Community Child Health Network, and will include 940 Black and 408 Hispanic mothers (76% of the sample). The aims are to: Aim 1. Identify subgroups of mothers with different symptom profiles at 6 months postpartum using latent profile analysis. This approach will allow identifying subgroups of mothers who share similar symptom severity experiences (profile) and those who are at-risk for worse symptom experiences so that personalized interventions can be developed. Aim 2. Examine individual-, relationship-, and community-level social determinants of health (SDOH) associated with each symptom profile. This will provide important knowledge as to which SDOH influence postpartum symptom profiles. Aim 3. Examine the association between allostatic load and each symptom profile. Allostatic load is a marker of cumulative physiological wear and tear that has a subsequent impact on cardiovascular and metabolic health (e.g., obesity), which contribute to maternal mortality and morbidity. Yet, the relationship between allostatic load and postpartum symptom profiles is unknown. Therefore, examining this relationship will provide novel insights into the health risks of postpartum mothers that will contribute to new targeted intervention strategies. This study aligns well with the National Institute of Nursing Research Strategic Plan to promote personalized symptom management and special interest priority in SDOH. Findings will provide important knowledge that can advance our understanding of postpartum symptom profiles and SDOH to inform future research. Training: The mentorship team with substantive and methodological expertise will support the applicant’s training to successfully conduct the study and prepare for her future steps as a nurse scientist. The following training goals are to gain and expand knowledge in: (1) complex postpartum symptom experiences and SDOH; (2) advanced quantitative methods used to characterize postpartum symptom profiles; (3) methods used in symptom science research and analysis of large data; and (4) intervention development to improve postpartum symptom experiences.