(Description) Preterm delivery (PTD) continues to be one of the most significant unsolved problems of public health and perinatology. There is increasing evidence that PTD is a complex cluster of problems with a set of overlapping factors and influences. As recently summarized by the Institute of Medicine (IOM) the causes of PTD include individual-level behavioral and psychological factors, environmental exposures, medical conditions, biological factors, and genetics, many of which occur in combination. Members of the IOM expert panel also noted that persistent methodological limitations in previous studies, including treating PTD as a single entity and failure to recognize important common pathophysiological pathways that may lead to PTD (e.g., systematic inflammation, endothelial dysfunction, oxidative stress, and placental ischemia) have hindered discovery of potential treatment and prevention strategies. Previous studies have not rigorously evaluated the independent and joint effects of potent highly relevant social and neuropsychological risk factors of PTD in high risk populations. Increased efforts that integrate interdisciplinary research approaches are clearly needed to understand PTD from biological, clinical, and public health perspectives. The overarching objective of this study is to provide much-needed fundamental information concerning risk of PTD in relation to women's mental health status and exposure to violence before and during pregnancy. We will develop a prospective cohort of 6,000 Peruvian women. We will study the relation of maternal history of childhood sexual abuse, lifetime- and pregnancy-IPV with the prevalence of mood and anxiety disorders (e.g., major depression, minor depression, generalized anxiety and post-traumatic stress disorder [PTSD]). We will also study associations of PTD risk with mood disorder and anxiety disorder early in pregnancy. We will evaluate the extent to which risk of PTD is influenced by alternations in multiple biological markers of maternal neuroendocrine, vascular, and immune status. Finally, we will study the mediational effect of maternal mental health and physiological status in the relation between IPV and PTD.
Public Health Relevance Statement (Project Narrative-revised) Preterm delivery (PTD) continues to be one of the most significant unsolved problems of public health and perinatology. There is increasing evidence that PTD is a complex cluster of problems with a set of overlapping factors and influences. Violence against women is a more serious and widespread problem than previously recognized. Results from studies conducted in some countries indicate that 10-52 percent of women report physical abuse by an intimate partner at some point in their lives, and that 10-27 percent of women report experiences of sexual abuse. Mood and anxiety disorders, like intimate partner violence (IPV), are prevalent among reproductive age women, and are risk factors of preterm delivery (PTD) an important determinant of infant mortality. We submit that our research is significant and can make a difference insofar as helping to: (1) identify those at greatest risk (i.e. Among women exposed to IPV, who is at risk for adverse outcomes?) and (2) identify specific targets for intervention (i.e. Should interventions be directed at management of mood or anxiety symptoms in pregnancy? At mitigating neuroendocrine consequences of PTSD? Or at providing anti-inflammatory therapy?). Exposure to IPV is an important risk factor for PTD. However, that knowledge alone has limited practical value because eliminating IPV is probably not a feasible goal for healthcare systems. Our overarching goal, therefore, is to generate new knowledge that can be used to design and implement interventions based in the healthcare system;and to understand pathways from IPV to PTD. These goals are in accordance with those articulated by the Institute of Medicine90 and the recent US Surgeon's General's Conference on the Prevention of Preterm Birth233;and are underscored by the U.S. Congress'passing of the Prematurity Research Expansion and Education for Mothers who Deliver Infants Early (PREEMIE) Act (P.L. 109-450)234.
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