Cesarean delivery in overweight and obese women: patient and systems factors

该K99/R 00奖将提供卫生服务研究和临床产科实践方面的培训，以将候选人培养成独立的跨学科研究人员，重点关注生殖健康差异。在美国，剖宫产率已达到流行病的比例。超重和肥胖妇女剖宫产的风险增加，剖宫产后的短期和长期发病率也增加。然而，人们对如何为超重/肥胖女性提供最佳产科护理，以最大限度地提高她们成功阴道分娩的机会知之甚少。病人和系统因素是决定分娩方式的重要因素。剖宫产存在种族/民族差异，肥胖和种族的相对贡献尚不清楚。此外，很少有人知道的影响忙碌（高容量）天在劳动和分娩剖宫产率。该项目旨在解开肥胖和种族/民族的影响，并建立每日产科量的影响，剖宫产。拟议的K99/R 00研究将使用包含不同出生人群（加州）的大型管理数据集，以梳理肥胖和种族/民族对分娩方式的影响，探索影响修改的可能性。这种类型的相互作用已被观察到肥胖和种族对其他产科结局的影响。K99阶段将允许候选人制定每日产科量的度量标准，或者在给定的一天中分娩单位有多忙碌。在R 00阶段，候选人将分析高产日数对未经产、足月、单胎、头位剖宫产率的影响。还将在超重/肥胖人群和少数民族妇女亚群中进行分析，以了解产科护理过程的改变是否会对结果产生差异。这些创新的分析和方法将提供急需的信息，非医学预测剖宫产的妇女在最大的风险，不良妊娠结局。俄勒冈州健康与科学大学是进行这种培训和研究的理想场所，因为它在临床产科，产科结局研究和卫生服务研究方面处于领先地位。候选人还将利用俄勒冈州临床和转化研究所的资源，促进专业发展，并促进向研究独立性的过渡。

DESCRIPTION (provided by applicant): This K99/R00 Award will provide the training in health services research and clinical obstetric practice needed to develop the candidate into an independent interdisciplinary researcher focusing on reproductive health disparities. The rate of cesarean delivery has reached epidemic proportions in the U.S. Overweight and obese women are at increased risk of cesarean, as well as short-term and long-term morbidities subsequent to cesarean delivery. However, very little is known about how to optimally provide obstetric care to overweight/obese women, to maximize their chance of successfully achieving a vaginal delivery. Patient- and systems-level factors are important determinants of mode of delivery. There are racial/ethnic disparities in cesarean delivery, and the relative contribution of obesity and race i unknown. Additionally, very little is known about the effect of busy (high-volume) days in Labor & Delivery on cesarean delivery rates. This project aims to disentangle the effects of obesity and race/ethnicity, and establish the impact of daily obstetric volume, on cesarean delivery. The proposed K99/R00 study will use a large administrative dataset containing a diverse population of births (California) to tease out the impact of obesity and race/ethnicity on mode of delivery, exploring the possibility of effect modification. Interaction of this type has been observed for obesity and race effects on other obstetric outcomes. The K99 phase will allow the candidate to develop a metric of daily obstetric volume, or how busy a Labor & Delivery unit is on a given day. In the R00 phase, the candidate will analyze the impact of high-volume days on the nulliparous, term, singleton, vertex cesarean delivery rate. Analyses will also be conducted within the overweight/obese populations and among subgroups of racial minority women, to see if altered processes of obstetric care affect their outcomes differentially. These innovative analyses and methodologies will provide much-needed information on non-medical predictors of cesarean delivery among women at the greatest risk of adverse pregnancy outcomes. Oregon Health and Science University is the ideal setting to conduct this training and research, because of its leadership in clinical obstetrics, obstetric outcomes research, and health services research. The candidate will also leverage the resources at the Oregon Clinical and Translational Research Institute to foster professional development and facilitate the transition to research independence.