John Thorp, Jr., MD - Division of Women's Primary Healthcare
The overall goal of the Community Child Health Network (CCHN) is to gain new insights into reasons for the disparities in maternal health and child development. The goals of the Network’s first study are to 1) examine the factors associated with maternal allostatic load (a possible factor in poor pregnancy outcomes), and 2) evaluate the usefulness of community-partnered participatory research for conducting research on health disparities. These goals will be achieved through a community-academic partnered, multi-center observational study with the following 2 specific aims: 1) determine the factors associated with maternal allostatic load, and 2) explore the relationship between maternal allostatic load during the interconceptional period and birth/child health outcomes in a subsequent pregnancy. In phase I, we will examine factors associated with allostatic load, with particular attention to two understudied areas: the influence of community and of paternal factors and will establish a framework for exploring the link between maternal allostatic load and birth/child health outcomes in subsequent phases of the study.
The proposed study is a five-year, multi-site, prospective cohort study of the influences of stress and resilience on maternal allostatic load and birth outcomes. A cohort of 4,000 families will be recruited at delivery of the index child, with oversampling among African American and Latina women, and women with preterm birth. Periodic assessment of the mother, father, and their relationship will occur via in-person visits at 1, 6, 12, and 24 months and per trimester during subsequent pregnancy (with an abbreviated telephone interview at 18 months); individual, family, community and institutional stressors and resilience factors will be recorded. Biomarkers will be collected at 6, 12, and 24 months. The influences of stress and resilience on maternal allostatic load will be analyzed using canonical correlation analyses, structural equation modeling and multilevel analyses. Based on Baltimore Healthy Start experience, we estimate that 38% of mothers in the cohort will give birth to a subsequent child during the study period; the relationship between their allostatic load and subsequent birth outcomes will be explored.
North Carolina persists in having maternal and child health disparities in preterm birth, infant mortality, and access to health care. These poor birth outcomes disproportionately affect families in the predominately rural Eastern part of the state. Partnered together in this community based, multilevel research project will be the UNC Center for Women’s Health Research, East Carolina University, and the Eastern North Carolina Baby Love Plus Project. Eastern NC community partners have participated fully in the research planning and will have crucial roles to play in the initiation, conduct, and analyses of this cohort study.