NHLBI Community Engagement Technical Assistance Center (CETAC)

在过去的三十年里，孕产妇死亡率出现了令人震惊的上升趋势 美国的发病率和死亡率。总体而言，已确定的母婴传播疾病的临床原因 死亡原因：心血管疾病(14%)、出血(13%)、感染(11%)、血栓 (10%)、心肌病(95%)、精神健康状况(9%)和先兆子痫/子痫(8%) 但这些情况因种族/民族而异。对于黑人，非西班牙裔女性，两位主要的 死亡原因是心肌病和心血管疾病，以及精神疾病 是非西班牙裔白人女性的主要原因。1肥胖、高血压、吸烟、 阿片类药物的使用和睡眠障碍也是已经发现的情况和行为 与产妇发病率有关，如出血、先兆子痫和心肌病。 这些问题可能在怀孕前和怀孕之间的初级保健中得到解决。2-6 国家心肺血液研究所(NHLBI)正在参加一项跨国研究所的 美国国家卫生研究院(NIH)努力改善妇女健康，特别是产妇发病率和死亡率。一个 促进妇女健康的科学计划--跨美国国立卫生研究院妇女战略计划 健康研究--是为2019-2023年期间制定的。该计划提供了一个框架 它认识到影响妇女健康的多种因素的复杂相互作用 生命历程，包括怀孕。生命历程理论认为，健康发展始于 在受孕之前，并在一生中持续。这表明，一场复杂的 生物、行为、心理、社会保护和风险因素有助于健康 结果，健康状况反映了终生接触这些因素的累积情况。这个 该计划的指导原则是考虑影响妇女健康的复杂因素 健康，纳入不成比例地受发病率和 死亡率，以及不同科学家群体的积极参与。 美国国立卫生研究院降低产妇发病率和死亡率的办法将旨在增进健康。 差异研究，增加对社会决定因素和其他风险因素的了解 (包括环境风险因素)，改善护理(产前、产中和产后) 和管理，提供对心理暴露的洞察，如压力、歧视和 照顾，了解受产妇发病率或死亡率影响的家庭的应对行为， 并调查隐性偏见在有关怀孕的卫生保健系统中的作用。 保健、孕产妇和妇女健康优先事项跨越保健保健战略的所有目标 VISION，NHLBI已经支持了一些产妇保健项目，这些项目着眼于 高血压、睡眠障碍和其他妊娠并发症，包括先兆子痫， 子痫和妊娠期糖尿病。 NHLBI 3M行政协调中心(3M ACC)的目标是参与 产妇发病率高的地区和地区的社区和网络 死亡率。3M行政协调委员会将支持必要的前期工作，以确定和准备 一组以社区为基础的组织，以应对未来的筹资机会。3M 行政协调会将发展基础设施，以支持这组产妇发病率和死亡率。 区域联盟(3M RCS)，并为NHLBI提供科学支持和协调 新兴的科学需求。具体而言，3M行政协调委员会将支持以下方案目标： ·确定具有现有和相关专业知识的研究小组和组织 社区伙伴关系。 ·进行景观分析和社区了解的需求评估。 ·确定每个社区内需要改进的实施机会和障碍 提供循证护理，以减少产妇发病率和死亡率。 ·开发并进行实施方法的早期测试，以确定潜力 确保建议的方法是可接受、可行、可扩展和 可持续的，并找出障碍。

Over the past three decades, there have been alarming upward trends in the rates of maternal morbidity and mortality in the United States. Overall, the identified clinical causes of maternal death are: cardiovascular conditions (14%), hemorrhage (13%), infection (11%) embolism (10%), cardiomyopathy (95), mental health conditions (9%) and preeclampsia/eclampsia (8%) but these conditions vary by race/ethnicity. For Black, non-Hispanic women, the two leading causes of death were cardiomyopathy and cardiovascular conditions, and mental conditions was the leading cause among White, non-Hispanic women.1 Obesity, hypertension, smoking, opioid use and sleep disorders are also conditions and behaviors that have been found to be associated with maternal morbidity such as hemorrhage, preeclampsia and cardiomyopathy. These could potentially be addressed in primary care before and between pregnancies.2-6 The National Heart, Lung Blood Institute (NHLBI) is participating in a trans-National Institutes of Health (NIH) effort to improve women’s health, particularly maternal morbidity and mortality. A plan – Advancing Science for the Health of Women, The Trans-NIH Strategic Plan for Women’s Health Research – was developed for the period 2019 – 2023. This plan provides a framework that recognizes the complex interactions of multiple factors that affect women’s health across the life course, including pregnancy. Life course theory posits that health development begins before conception and continues across the life span. It suggests that a complex play of biologic, behavioral, psychological, and social protective and risk factors contribute to health outcomes, and that health status reflects the cumulative lifetime exposure to these factors. The guiding principles for this plan are consideration of the complex factors affecting women’s health, the inclusion of diverse populations that are disproportionately affected by morbidity and mortality, and active engagement of a diverse group of scientists.7 The NIH approach to reducing maternal morbidity and mortality will aim to enhance health disparities research, increase the understanding of social determinants and other risk factors (including environmental risk factors), improve care (antepartum, intrapartum and postpartum) and management, provide insight to psychological exposures such as stress, discrimination and caregiving, understand coping behaviors in families affected by maternal morbidity or mortality, and investigate the role of implicit bias in the health care systems regarding pregnancy.8 Within NHLBI, maternal and women’s health priorities span all of the objectives of the NHLBI strategic vision, and NHLBI has supported a number of maternal health programs looking at hypertension, sleep disorders, and other pregnancy complications including pre-eclampsia, eclampsia, and gestational diabetes. The goal of the NHLBI 3M Administrative Coordinating Center (3M ACC) is to engage communities and networks in areas that experience high levels of maternal morbidity and mortality. The 3M ACC will support the preliminary work necessary to identify and prepare a group of community-based organizations to respond to future funding opportunities. The 3M ACC will develop the infrastructure to support this group of Maternal Morbidity and Mortality Regional Coalitions (3M RCs) and provide scientific support and coordination to NHLBI on emerging scientific needs. Specifically, the 3M ACC will support these programmatic objectives: • Identify research groups and organizations with existing and relevant expertise and community partnerships. • Conduct landscape analyses and community-informed needs assessments. • Identify within each community implementation opportunities and barriers to improve delivery of evidence-based care to reduce maternal morbidity and mortality. • Develop and conduct early-stage tests of implementation approaches to identify potential strategies to ensure the proposed approaches are acceptable, feasible, scalable, and sustainable and to identify barriers.