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

摘要(摘自家长赠款R01 NR017020) 严重孕产妇发病率(SMM)包括对孕产妇健康和生存的严重威胁 分娩或产后。基于CDC开发的SMM指数，该指数专注于最具生命威胁的 由于病情和并发症，SMM的患病率在1998-2011年间翻了一番，目前影响65,000人 美国每年都有女性。产妇健康对于妇女照顾孩子和 她的健康贯穿了她的一生，但我们对SMM的病因了解有限。这项提案涉及 SMM研究的三个关键和未被充分研究的领域：种族/民族差异、母亲体重和 社会劣势。SMM中的种族/民族差异及其促成条件是众所周知的-风险 在非西班牙裔黑人中，SMM往往高出2倍，在西班牙裔美国人中，SMM率高出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，母亲的体重和社会劣势可能是原因之一。在美国，25%的女性 怀孕时肥胖，一半在怀孕期间超重，25%的人体重保持在10磅。产后，但是 这因种族而异--民族。一些研究表明肥胖与SMM有关，但很少有这样的研究 检查肥胖的严重程度、体重不足状况或体重变化。社会劣势要严重得多 这在非白人中比白人中常见，并与无数围产期结局有关，但几乎没有研究 已经审查了它对SMM的贡献。异常高和低的母亲体重和体重增加最多 很可能是在社会处境不利的妇女中，但它们对SMM的相互关联影响尚未得到研究。 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了解 通过分析2007-2014年间加州出生的400万人，得出了不同的结论。这些数据包括至关重要的 记录和母婴医院从怀孕到产后的出院数据。结果将会 包括导致SMM的最常见情况-产后出血、子痫/严重 子痫前期、部分心血管疾病和败血症--以及疾控中心开发的SMM指数。 具体目标是：1)检查母亲体重状况与前、中、后之间的关系 患有SMM的妊娠以及它们是否受到种族/民族的影响；2)检查多水平的相关性 (个人、家庭、邻里)SMM的社会劣势指标，总体上和按种族/族裔划分 (目标2a)，以及这些关系在多大程度上受母亲体重状况的影响(目标2b)； 调查母亲体重状况和社会弱势对#年人口负担的贡献 SMM及其种族/族裔差异。拟议中的研究将通过研究该建筑群来开辟新的天地 母亲体重、社会劣势、种族/民族差异和SMM之间的关系。这一知识 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.