Trans-generational Impact of Maternal Obesity and Diabetes on Health Disparities

描述(由申请人提供)：由于肥胖和糖尿病对育龄妇女的影响越来越大，了解它们对后代健康的公共健康影响是至关重要的。如果肥胖和糖尿病的宫内环境在很大程度上助长了这些流行病，不仅其在所有人口中的流行率将继续增加，而且肥胖症和糖尿病发病率高的人群将继续受到不成比例的影响，导致种族和族裔群体之间的健康差距不断扩大。黑人和西班牙裔女性是美国最大的两个少数群体，她们不仅在怀孕期间比非西班牙裔白人女性更容易肥胖和患有糖尿病，而且她们的体脂分布不同，她们的糖尿病更严重，她们比非西班牙裔白人女性有更高的心血管风险。尽管如此，相对较少的研究考察了肥胖和糖尿病宫内环境中潜在的种族/民族差异。南卡罗来纳州(南卡罗来纳州)主要位于美国东南部的农村和中部，该地区历史上一直受到肥胖症、糖尿病和种族健康差距的困扰。我们建议调查和描述妊娠期糖尿病和肥胖的流行病学以及相关的出生结局，这是一个基于人群的环境，并使用模拟模型来预测怀孕期间母体肥胖和糖尿病在人群水平上跨越多代人的潜在影响。针对题为“NCMHD针对少数群体和服务不足人群的健康差距研究(R01)”的RFA-MD-09-004，我们将能够(1)在南卡罗来纳州检查孕产妇糖尿病和肥胖对母婴结局种族差异的影响，(2)检查宫内环境作为糖尿病和肥胖症影响南卡罗来纳州不同种族/族裔婴儿结局的机制，(3)使用离散事件模拟模型预测美国黑人、非西班牙裔白人和拉美裔美国人中母亲在孕期肥胖和糖尿病对后代患病率的影响。这项研究具有创新性，因为团队负责人由一名系统工程师和一名流行病学家组成，他们提议使用系统工程方法(模拟)进行超出流行病学研究可行性的研究。我们假设的概念框架是，母亲的健康影响其婴儿的健康，而婴儿的健康反过来定义了人口的健康，并随后影响到下一代。这项研究针对的是目前未予研究的关键领域：产妇肥胖和糖尿病对人口一级婴儿健康的影响，以及在肥胖和糖尿病方面可能扩大的种族/族裔健康差距。

DESCRIPTION (provided by the applicant): As obesity and diabetes increasingly affect women of childbearing age, understanding their public health impact on offspring health is paramount. If the obese and diabetic intrauterine environments are substantially contributing to these epidemics, not only will their prevalence continue to increase across all populations, but populations with a high prevalence of obesity and diabetes will continue to be disproportionately affected, resulting in a perpetual widening of health disparities between racial and ethnic groups. Black and Hispanic women, members of the two largest minority groups in the U.S., are not only more likely to be obese and have diabetes during pregnancy than non-Hispanic white women, but their body fat is distributed differently, their diabetes is more severe, and they have higher cardiovascular risk than non-Hispanic white women. Despite this, relatively few studies have examined potential racial/ethnic differences in the obese and diabetic intrauterine environments. South Carolina (SC) is largely rural and centrally located in the Southeastern United States, an area of the country historically plagued by obesity, diabetes and racial health disparities. We propose to investigate and characterize the epidemiology of diabetes and obesity during pregnancy and related birth outcomes in SC, a population-based setting, and to use a simulation model to predict the potential impact of maternal obesity and diabetes during pregnancy at the population level across multiple generations. Responding to RFA-MD-09-004 entitled, "NCMHD Health Disparities Research on Minority and Underserved Populations (R01)" will enable us to (1) examine the impact of maternal diabetes and obesity on racial disparities in maternal and infant outcomes in SC, (2) examine the intrauterine environment as a mechanism through which diabetes and obesity differentially impact infant outcomes across racial/ethnic groups in SC and (3) use a discrete event simulation model to predict the impact of maternal obesity and diabetes during pregnancy on their prevalence in subsequent generations in blacks, non-Hispanic whites and Hispanics in the United States. The research is innovative in that the team leaders consist of a systems engineer and an epidemiologist who proposes to use a systems engineering approach (simulation) to conduct research that goes beyond what is feasible in epidemiologic studies. The conceptual framework for our hypotheses is that a mother's health impacts her infant's health which in turn defines the population's health and subsequently impacts the next generation. Critical areas currently understudied are targeted by the study: the effects of maternal obesity and diabetes on infant health at the population level and a potential widening of racial/ethnic health disparities with respect to obesity and diabetes.