The Role of Social Support as a Buffer Against Adverse Perinatal Outcomes Among Women Experiencing Discrimination and Neighborhood Deprivation

项目总结 婴儿的不良出生结局会在整个生命过程中影响健康，以及先兆子痫和产后 抑郁症对产妇发病率和死亡率有很大影响。剥夺邻里关系和 歧视与这些不良的围产期结局及其差异有关，但很难 制定干预措施以限制这些有害的暴露。研究表明，社会支持是一种可修改的 可以缓冲母亲压力对某些分娩结果的不利影响的特征，但效果较差 知道它有可能缓冲邻里剥夺和歧视对围产儿的影响 结果。目标1将评估产前社会支持对邻里关系影响的程度 对不良分娩结局的剥夺，包括早产、低出生体重和小于胎龄儿。 目标2将考察产前社会支持在多大程度上改变邻里剥夺的影响 先兆子痫。目标3将调查出生后社会支持在多大程度上改变 产后抑郁症辨析。未经产妊娠结局研究：监测母亲至母亲 目标1和目标2将使用9,289个怀孕的多地点队列。在这个队列中，邻居 剥夺用面积剥夺指数(ADI)测量，社会支持用 领悟社会支持多维度量表(MSPSS)社区和儿童健康网 2,510名孕妇的多地点队列将用于目标3。在该队列中，通过 日常生活辨别量表(EDS)、产后社会支持用医疗结局量表测评 研究(MOS)社会支持量表，产后抑郁症用爱丁堡产后量表测量 产后1、6、12个月进行抑郁量表(EPDS)评定。我们的假设是， 社区剥夺和对围产期结局的歧视将在高龄妇女中减少 感受到的社会支持与感受到的社会支持低的女性相比，其次是 缓冲效应因种族群体和社会支持类型而异。我们的发现可以帮助我们了解 在产前护理中进行心理社会风险筛查，以帮助确定最有可能受益的孕妇 来自资源，如支持小组、保险覆盖的双胞胎和通过 对哪种类型的社会支持最有效以及对哪种结果的细致入微的理解。这个 计划的研究和培训目标将丰富申请者在高级流行病学方面的严格培训 方法、心理社会流行病学、围产期健康差异和产前临床护理，以及提供 她的职业发展为她过渡到博士后研究员职位做准备。配备了一台强大的 导师团队和埃默里丰富的培训环境，这一奖学金将为 申请者的长期目标是领导一个独立的研究项目，专注于精神和心理健康 在更广泛的社会环境范围内，确保怀孕妇女的心理社会健康。

PROJECT SUMMARY Adverse birth outcomes in infants affect health over the life course, and preeclampsia and postpartum depression contribute significantly to maternal morbidity and mortality. Neighborhood deprivation and discrimination are associated with these adverse perinatal outcomes and their disparities, but it is difficult to develop interventions to limit these harmful exposures. Research suggests that social support is a modifiable characteristic that can buffer against the adverse effects of maternal stress on some birth outcomes, but less is known about its potential to buffer the effects of neighborhood deprivation and discrimination on perinatal outcomes. Aim 1 will evaluate the degree to which prenatal social support modifies the effect of neighborhood deprivation on adverse birth outcomes, including preterm birth, low birth weight, and small for gestational age. Aim 2 will examine the degree to which prenatal social support modifies the effect of neighborhood deprivation on preeclampsia. Aim 3 will investigate the degree to which postnatal social support modifies the effect of discrimination on postpartum depression. The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to- Be multi-site cohort of 9,289 pregnancies will be used for Aims 1 and 2. In this cohort, neighborhood deprivation was measured by the Area Deprivation Index (ADI) and social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). The Community and Child Health Network multi-site cohort of 2,510 pregnancies will be used for Aim 3. In this cohort, discrimination was measured by the Everyday Discrimination Scale (EDS), postnatal social support was measured by the Medical Outcomes Study (MOS) Social Support Scale, and postpartum depression was measured by the Edinburgh Postnatal Depression Scale (EPDS) at 1, 6, and 12 months postpartum. The hypothesis is that the adverse effects of neighborhood deprivation and discrimination on perinatal outcomes will be diminished among women with high perceived social support compared to women with low perceived social support and secondarily that this buffering effect will differ by racial group and by type of social support. Our findings could help inform the value of psychosocial risk screening in prenatal care to assist in identifying pregnant women most likely to benefit from resources such as support groups, insurance-covered doulas, and new interventions developed with a nuanced understanding of which types of social support are most effective and for which outcomes. The planned research and training goals will enrich the applicant’s rigorous training in advanced epidemiologic methods, psychosocial epidemiology, perinatal health disparities, and prenatal clinical care, as well as provide professional development in preparation for her transition to a postdoctoral fellowship. Equipped with a strong mentoring team and Emory’s rich training environment, this fellowship will provide a strong foundation for the applicant’s long-term goal of leading an independent research program that focuses on the mental and psychosocial health of women who enter pregnancy, within the context of their broader social environments.