Community Response to Maternal/Child Health Disparities

Cedars-Sinai Medical Center, West Hollywood CA

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): Our academic and community-based collaborative will plan a multi-site, multi-level study that examines the interrelating biological and social-behavioral factors that contribute to health disparities in pregnancy outcomes and infant and early childhood mortality and morbidity. The overall hypothesis of Proposed Study #1 is that compared to women who deliver at term, those who deliver preterm have increased psychosocial stress, HPA hyperactivity, cytokilne dysregulation, cervico-vaginal infection and inflammation, and maladaptive stress-coping behavior. Women who deliver preterm are also more likely to have greater genetic, psychological, behavioral, and environmental susceptibilities to these stress-mediated pathways to preterm delivery. The increased prematurely risk among African Americans is partially related to both increased exposures and increased vulnerabilities to stress. Using multi-level analyses, we will examine the relationship between stress and preterm delivery in the context of racial-ethnic differences in genetic, neuroendocdne, immunologic, behavioral psychosocial and environmental vulnerabilities. The subjects will undergo serial assessments during pregnancy of psychosocial stress, HPA activity, cytokine expression, infection-inflammation, gone polymorphism, and multi-level protective and risk factors. These parameters will be compared between women who deliver preterm (cases) and term (matched controls). The overall hypothesis of Proposed Study # 2 is that, compared to those who do not develop reactive airway disease, infants who develop asthma by age 3 are more likely to inherit disease susceptibility genotypes, experience increased psychosocial stress and exaggerated neonatal hypothalamic- pituitary axis reactivity, and impaired parentchildinteraction. Furthermore, we hypothesize that the increased risk of reactive airway disease amongst African American and Hispanic children is partially related to increased environmental stress exposures and partially related to increased biologic susceptibility to asthma due to inherited genotypes and increased susceptibility to stress. Both studies are cohort studies with nested case-control design. 25,000 pregnant women will be recruited per year over a four-year study period. The proposed study requires that one-third of study participants be women who self identify as Black or African American, and one-third Asian or Hispanic. The long range goal of this study is to reduce racial-ethnic disparities in birth and child health outcomes through novel research programs conducted through an academic-community collaborative in the richly diverse communities of Los Angeles County.