Severe Maternal Morbidity: An Investigation of Racial-Ethnic Disparities, Social Disadvantage & Maternal Weight

摘要（来自母基金R 01 NR 017020） 重度孕产妇死亡包括对孕产妇健康和生存的严重威胁， 分娩或产后。根据疾病预防控制中心制定的SMM指数， 自1998年至2011年，SMM的患病率翻了一番，目前影响了超过65，000人 美国女性每年。产妇保健对妇女照顾子女和 她的健康在她的生命历程，但我们的了解SMM的原因是有限的。该提案涉及 SMM研究的三个关键和未充分研究的领域：种族/民族差异，产妇体重， 社会弱势。SMM中的种族/族裔差异及其促成条件是众所周知的-风险 SMM在非西班牙裔黑人中往往高出2倍，在西班牙裔中高出1.5倍， 亚洲人，相对于非西班牙裔白人。对这些差异的解释尚不清楚，但初步 有证据表明，母亲的体重和社会不利地位可能是原因之一。在美国，25%的女性 怀孕时肥胖，一半的人在怀孕期间体重增加过多，25%的人体重超过10磅。产后，但 这是因种族而异的。一些研究表明，肥胖与SMM有关，但很少有研究表明， 检查肥胖、体重不足状态或体重变化的严重程度。社会劣势比 在非白人中比白人更常见，与无数围产期结局相关，但几乎没有研究 他们研究了对SMM的贡献。异常高和低的母亲体重和体重增加是最常见的 可能在社会弱势妇女中存在，但尚未研究其对SMM的相互影响。 我们的目标是增加对SMM及其种族/民族的生物和社会决定因素的理解 差异，通过分析2007- 2014年间加州的400万新生儿。数据包括重要的 记录和母亲和婴儿从怀孕到产后的出院数据。成果将 包括导致SMM的最常见疾病-产后出血、子痫/重度 先兆子痫、选择性心血管疾病和败血症-以及CDC开发的SMM指数。 具体目的是：1）检查孕妇体重状况的关联之前，期间，和之间 SMM妊娠，以及它们是否因种族/民族而改变; 2）检查多水平 总体和按种族/族裔分列的社会弱势（个人、家庭、邻里）指标 (Aim 2a），以及这些关系在多大程度上由母体体重状况介导（目标2b）;以及3） 调查产妇体重状况和社会不利因素对人口负担的影响， SMM及其种族/民族差异。拟议中的研究将通过研究复杂的 产妇体重，社会劣势，种族/民族差异和SMM之间的关系。这些知识 对于制定有效的公共卫生和临床干预措施以减少SMM及其 差异，包括产妇体重的指导方针。

ABSTRACT (from parent grant R01 NR017020) Severe Maternal Morbidity (SMM) includes serious threats to maternal health and survival that occur at delivery or postpartum. Based on the SMM index developed by CDC that focuses on the most life--threatening conditions and complications, the prevalence of SMM doubled from 1998-2011 and currently affects >65,000 women in the U.S. each year. Maternal health is essential to a woman’s ability to care for her children and to her health over her life course, yet our understanding of causes of SMM is limited. This proposal addresses three key and understudied areas of research for SMM: racial/ethnic disparities, maternal weight, and social disadvantage. Racial/ethnic disparities in SMM and its contributing conditions are well known – risk of SMM tends to be up to 2-fold higher among non-Hispanic blacks and 1.5-fold higher among Hispanics and Asians, relative to non-Hispanic whites. The explanation for these disparities is unknown, but preliminary evidence suggests that maternal weight and social disadvantage may contribute. In the U.S., 25% of women are obese at conception, half gain excessive weight during pregnancy, and 25% retain >10 lb. postpartum, but this varies by race--ethnicity. Some studies suggest an association of obesity with SMM, but few have examined severity of obesity, underweight status, or weight change. Social disadvantage is much more common among non--whites than whites and associated with myriad perinatal outcomes, but almost no studies have examined its contribution to SMM. Unusually high and low maternal weight and weight gain are most likely among socially disadvantaged women, but their inter-related impacts on SMM have not been studied. Our goal is to increase understanding of biologic and social determinants of SMM and its racial/ethnic disparities, by analyzing 4 million births that occurred in California from 2007--2014. The data include vital records and mother and infant hospital discharge data from pregnancy through postpartum. Outcomes will include the most common conditions that contribute to SMM – postpartum hemorrhage, eclampsia/severe preeclampsia, select cardiovascular conditions, and sepsis – as well as the SMM index developed by CDC. The Specific Aims are: 1) Examine associations of maternal weight status before, during, and between pregnancies with SMM and whether they are modified by race/ethnicity; 2) Examine associations of multi-level (individual, household, neighborhood) indicators of social disadvantage with SMM, overall and by race/ethnicity (Aim 2a), and the extent to which these relationships are mediated by maternal weight status (Aim 2b); and 3) Investigate the contribution of maternal weight status and social disadvantage to the population burden of SMM and its racial/ethnic disparities. The proposed research will break new ground by studying the complex relationships among maternal weight, social disadvantage, racial/ethnic disparities, and SMM. This knowledge is essential to the development of effective public health and clinical interventions to reduce SMM and its disparities, including guidelines for maternal weight.