Women & Infants Hospital Of Rhode Island

ENVIRONMENTAL INFLUENCES ON NEURODEVELOPMENTAL OUTCOME IN INFANTS BORN VERY PRETERM

COBRE FOR REPRODUCTIVE HEALTH

COBRE FOR PERINATAL BIOLOGY

PRENATAL METHAMPHETAMINE EXPOSURE AND SCHOOL AGED OUTCOME

FETAL AND NEONATAL NEUROBEHAVIOR AND PRENATAL ANTIDEPRESSANT EXPOSURE

COBRE FOR PERINATAL BIOLOGY

CLINICAL MARKERS OF NEONATAL OPIOID WITHDRAWAL SYNDROME: ONSET, SEVERITY AND LONGITUDINAL NEURODEVELOPMENTAL OUTCOME

EPIGENETIC PREDICTORS OF IMPAIRMENT IN VERY PRETERM INFANTS

MATERNAL LIFESTYLE STUDY PHASE 5

NICHD MATERNAL-FETAL MEDICINE UNITS (MFMU) NETWORK

SALIVARY DIAGNOSTICS FOR SEPSIS SCREENING IN THE NEONATE

CYTOKINES AND THE BLOOD-BRAIN BARRIER IN THE OVINE FETUS

NEONATAL NEUROBEHAVIOR AND OUTCOMES IN VERY PRETERM INFANTS

COMPARING GLYCEMIC PROFILES IN PREGNANCY AND MATERNAL AND CHILD HEALTH OUTCOMES

RHODE ISLAND COMMUNITY-BASED MATERNAL SUPPORT SERVICES (RI COMSS) BUNDLE FOR ADVANCING PERINATAL HEALTH EQUITY - DESPITE A DECREASING GLOBAL TREND, MATERNAL MORTALITY (MM) AND SEVERE MATERNAL MORBIDITY (SMM) IN THE UNITED STATES (US) CONTINUE TO INCREASE. BLACK, INDIGENOUS, AND PEOPLE OF COLOR (BIPOC) HAVE DISPROPORTIONATELY HIGHER RATES OF MM: BLACK BIRTHING PEOPLE HAVE A MM RATIO THAT IS 2 - 3 TIMES HIGHER THAN WHITE BIRTHING PEOPLE. THE CAUSES OF SMM/MM AND THE ASSOCIATED DISPARITIES ARE COMPLEX AND MULTIDIMENSIONAL INCLUDING STRUCTURAL RACISM AND INEQUITIES IN THE LONGITUDINAL PROVISION OF PRECONCEPTION, ANTENATAL, DELIVERY, AND POSTPARTUM CARE AT THE SYSTEM-, PROVIDER-, AND PATIENT-LEVELS. THERE IS INCREASING AWARENESS OF THE IMPORTANT ROLE OF SOCIAL DETERMINANTS OF HEALTH (SDOH) – THE CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, LIVE, WORK, AND AGE – ON PERINATAL OUTCOMES. SDOH INCLUDING FOOD SECURITY, HOUSING STABILITY, SOCIAL SUPPORT, INCOME, EDUCATION, TRANSPORTATION, NEIGHBORHOOD ENVIRONMENT, AND EMPLOYMENT STATUS HAVE BEEN ASSOCIATED WITH ADVERSE PERINATAL HEALTH OUTCOMES. ADDRESSING PERINATAL HEALTH DISPARITIES REQUIRES A MULTIPRONGED APPROACH TARGETING NOT ONLY THE HEALTH SYSTEM AND CLINICAL FACTORS THAT CONTRIBUTE TO INADEQUATE CARE, BUT ALSO THE SOCIAL NEEDS OF PATIENTS FROM COMMUNITIES EXPERIENCING DISPARITIES. THE ABSENCE OF SUCH APPROACHES, AS IN RHODE ISLAND (RI), CONTRIBUTE TO PERSISTENT AND HIGH RATES OF SMM/MM AND RACIAL DISPARITIES. IN RI, SMM OCCURS IN 1 IN 36 BIRTHING PEOPLE (2.8%; DOUBLE THE U.S. AVERAGE OF 1.4%) WITH SIGNIFICANT RACIAL DISPARITIES: BLACK PATIENTS HAVE A 48% HIGHER RATE OF SMM COMPARED TO WHITE PATIENTS, AND LATINX PATIENTS HAVE A 32% HIGHER RATE OF SMM COMPARED WITH NON-LATINX PATIENTS. WOMEN AND INFANTS HOSPITAL OF RHODE ISLAND (WIH) PROPOSES A 5-YEAR PROJECT TO DEVELOP AND IMPLEMENT A PARTICIPATORY MODEL FOR INTEGRATING COMMUNITY-BASED MATERNAL SUPPORT SERVICES (COMSS) INTO PERINATAL SYSTEMS OF CARE. THE PURPOSE OF THIS PROJECT IS TO IMPROVE PERINATAL HEALTH OUTCOMES IN RI BY BRINGING TOGETHER WIH, COMMUNITY HEALTH WORKERS (CHWS) AND DOULAS, AND COMMUNITY-BASED ORGANIZATIONS IN A DEEPLY PARTICIPATORY PROCESS TO BUILD A SERVICE DELIVERY MODEL THAT ADDRESSES CARE COORDINATION AND SDOH (FOOD, HOUSING, TRANSPORTATION, SOCIAL SUPPORT) AS A PART OF A CONCERTED EFFORT TOWARDS ACHIEVING EQUITABLE PERINATAL HEALTH OUTCOMES. OVER 80% OF DELIVERIES IN RI OCCUR AT WIH, MAKING THE HOSPITAL A CRITICAL TOUCHPOINT FOR PERINATAL HEALTH. THROUGH THIS PROJECT, ALL PATIENTS WHO RECEIVE PRENATAL AND POSTPARTUM SERVICES AT WIH OR ONE OF 6 WIH-AFFILIATED CLINICS WILL BE SCREENED FOR 3 RISK FACTORS: SDOH, SUBSTANCE USE/BEHAVIORAL HEALTH DIAGNOSES, AND HIGH-RISK PREGNANCY FACTORS. A POSITIVE SCREEN WILL TRIGGER THE INVOLVEMENT OF A CARE MANAGER WHO WILL WORK WITH A TEAM OF CHWS, DOULAS, PHYSICIANS, AND COMMUNITY-BASED ORGANIZATIONS TO CREATE A PERINATAL HEALTH SUPPORT PLAN FOR THE PATIENT. BY CO-DESIGNING THE COMSS MODEL WITH COMMUNITY-BASED ORGANIZATIONS, THE PROJECT TEAM AIMS TO PROVIDE CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE COORDINATION THAT WILL REDUCE PERINATAL HEALTH INEQUITIES ACROSS THE STATE. IN YEAR ONE OF THE PROJECT, WIH WILL COORDINATE A PARTICIPATORY PROCESS TO FINALIZE THE DESIGN OF THE COMSS MODEL AND THE STRATEGY FOR IMPLEMENTATION INTO PERINATAL CARE. THE PROJECT TEAM WILL BRING TOGETHER PROJECT PARTNERS, DOULAS, COMMUNITY HEALTH WORKERS, OBSTETRIC CARE PROVIDERS, RELEVANT GOVERNMENT AGENCIES, AND COMMUNITY-BASED ORGANIZATIONS TO DEVELOP A PLAN FOR INCREASING ACCESS TO, AND USE OF, SUPPORTIVE SERVICES FOR PERINATAL HEALTH. IN YEARS TWO TO FOUR, THE PROJECT TEAM WILL SEQUENTIALLY ROLL OUT THE COMSS MODEL IN 6 WIH-AFFILIATED CLINICS. IN YEAR FIVE WE WILL DOCUMENT CONTINUED USE OF THE COMSS BUNDLE AFTER THE PROJECT ACTIVITIES HAVE ENDED (MAINTENANCE). AN INDEPENDENT EVALUATOR WILL COMPREHENSIVELY EVALUATE THE INTERVENTION AND DEVELOP A PLAN TO DISSEMINATE OUR FINDINGS TO THE BROADER PERINATAL HEALTH COMMUNITY.

BROWN/WIH PELVIC FLOOR DISORDERS NETWORK SITE (UG1)

HEALTH CARE INNOVATION CHALLENGE

BROWN MEDICAL SCHOOL/WIHRI DEPT OF OB/GYN WRHR PROGRAM

MOBILE WACH NEO: MOBILE SOLUTIONS FOR NEONATAL HEALTH AND MATERNAL SUPPORT

PROJECT REACH: PREVENTING POSTPARTUM DEPRESSION IN ADOLESCENT MOTHERS

ENVIRONMENTAL INFLUENCES ON NEURODEVELOPMENTAL OUTCOME IN INFANTS BORN VERY PRETERM

A MULTICENTER RANDOMIZED TRIAL OF IV VS ORAL IRON FOR TREATING IRON-DEFICIENCY ANEMIA IN PREGNANCY - ABSTRACT IRON-DEFICIENCY ANEMIA IS A COMMON, UNDER-TREATED PROBLEM IN PREGNANCY. THE PREVALENCE OF IRON-DEFICIENCY ANEMIA (ANEMIA PLUS IRON DEFICIENCY) IS ESTIMATED AT 16.2% OVERALL IN PREGNANCY AND UP TO 30% AT DELIVERY, AND IT IS ASSOCIATED WITH SIGNIFICANT ADVERSE MATERNAL AND FETAL OUTCOMES. WHILE TREATMENT WITH IRON SUPPLEMENTATION IS RECOMMENDED DURING PREGNANCY, IMPORTANT QUESTIONS REMAIN ABOUT THE OPTIMAL ROUTE OF DELIVERY. ORAL IRON THERAPY, THE CURRENT STANDARD, IS OFTEN SUBOPTIMAL: UP TO 70% OF PATIENTS EXPERIENCE SIGNIFICANT GASTROINTESTINAL SIDE EFFECTS THAT PREVENT ADHERENCE TO TREATMENT, RESULTING IN PERSISTENT ANEMIA. IN ADDITION, THE TIMING AND FREQUENCY OF ORAL IRON CAN INFLUENCE ABSORPTION. INTRAVENOUS (IV) IRON IS AN ATTRACTIVE ALTERNATIVE BECAUSE IT MITIGATES THE ADHERENCE AND ABSORPTION CHALLENGES OF ORAL IRON. HOWEVER, IT COSTS MORE, AND THERE ARE HISTORICAL CONCERNS ABOUT ADVERSE REACTIONS. THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS RECOMMENDS ORAL IRON FOR THE TREATMENT OF IRON-DEFICIENCY ANEMIA IN PREGNANCY, WITH IV IRON RESERVED FOR THE “RARE PATIENT WHO CANNOT TOLERATE OR WILL NOT TAKE ORAL IRON.” OUR PRELIMINARY DATA SHOW THAT THIS APPROACH LEADS TO 30% OF PATIENTS WITH PERSISTENT IDA AT DELIVERY AND AN ASSOCIATED 3 TO 6-FOLD INCREASED RISK OF PERIPARTUM BLOOD TRANSFUSION, A METRIC WITHIN THE CENTERS FOR DISEASE CONTROL AND PREVENTION’S SEVERE MATERNAL MORBIDITY COMPOSITE. THIS PREFERENTIAL RECOMMENDATION OF ORAL IRON IS BASED ON PAUCITY OF DATA ON THE BENEFITS AND SAFETY OF IV IRON, COMPARED WITH ORAL IRON, IN PREGNANCY. OUR PUBLISHED SYSTEMATIC REVIEW AND META-ANALYSIS SHOWED THAT IV IRON IS ASSOCIATED WITH GREATER INCREASE IN MATERNAL HEMOGLOBIN (HB), BUT MOST OF THE PRIMARY TRIALS WERE CONDUCTED IN DEVELOPING COUNTRIES, INCLUDED SMALL SAMPLE SIZES (50 – 252), AND DID NOT ASSESS MEANINGFUL MATERNAL AND NEONATAL OUTCOMES. THE CURRENT COCHRANE REVIEW NOTED THAT DESPITE THE HIGH INCIDENCE AND DISEASE BURDEN ASSOCIATED WITH IDA IN PREGNANCY, THERE IS PAUCITY OF QUALITY TRIALS ASSESSING CLINICAL MATERNAL AND NEONATAL EFFECTS OF IRON ADMINISTRATION IN WOMEN WITH ANEMIA. THE AUTHORS CALLED FOR “LARGE, GOOD QUALITY TRIALS ASSESSING CLINICAL OUTCOMES.” THE ONLY LARGE RANDOMIZED TRIAL OF IV VERSUS ORAL IRON, CONDUCTED IN INDIA, SHOWED NO DIFFERENCE IN A MATERNAL COMPOSITE OUTCOME BUT IS LIMITED BY USE OF IRON SUCROSE WITH A WIDE RANGE OF IRON DOSES (200 – 1600 MG) IN UP TO 5 INFUSIONS. IN ADDITION, THE PRIMARY COMPOSITE OUTCOME INCLUDED COMPONENTS NOT DIRECTLY RELATED TO ANEMIA. IN CONTRAST, OUR PILOT TRIAL OF A SINGLE INFUSION OF 1000 MG OF IV LOW MOLECULAR WEIGHT DEXTRAN IN PREGNANT WOMEN IN THE U.S. WITH MODERATE-TO-SEVERE IDA SIGNIFICANTLY REDUCED THE RATE OF MATERNAL ANEMIA AT DELIVERY AND SHOWED PROMISE FOR REDUCING RATES OF BLOOD TRANSFUSION. WE PROPOSE THE FIRST DEFINITIVE DOUBLE BLIND, PLACEBO CONTROLLED, MULTICENTER RANDOMIZED TRIAL IN PREGNANT WOMEN IN THE U.S. (N=746) TO TEST THE CENTRAL HYPOTHESIS THAT IV IRON IN PREGNANT WOMEN WITH MODERATE-TO-SEVERE IDA (HB<10 G/DL AND FERRITIN<30 NG/ML) AT 24 – 28 WEEKS WILL BE EFFECTIVE, SAFE AND COST-EFFECTIVE IN REDUCING PERIPARTUM BLOOD TRANSFUSION AND IMPROVE OFFSPRING NEURODEVELOPMENT. A MULTIDISCIPLINARY TEAM OF INVESTIGATORS IN THE U.S., WILL PURSUE THE FOLLOWING SPECIFIC AIMS: 1) EVALUATE THE EFFECTIVENESS AND SAFETY OF IV IRON, COMPARED WITH ORAL IRON, IN REDUCING THE RATE OF PERIPARTUM BLOOD TRANSFUSION IN PREGNANT WOMEN WITH MODERATE-TO-SEVERE IDA. (PRIMARY AIM); 2) ESTIMATE THE COST- EFFECTIVENESS OF IV IRON, COMPARED WITH ORAL IRON, IN PREGNANT WOMEN WITH MODERATE-TO-SEVERE IDA AS MEASURED BY INCREMENTAL COST PER QUALITY ADJUSTED LIFE-YEAR (QALY). (SECONDARY AIM 1); AND 3) ASSESS THE EFFECT OF IV IRON, COMPARED WITH ORAL IRON, ON OFFSPRING BRAIN MYELIN CONTENT AND NEURODEVELOPMENT. (SECONDARY AIM 2).

BRIDGING GAPS IN HEALTHCARE SERVICES FOR NEW FAMILIES DUE TO COVID-19 - PROJECT SUMMARY THE TRANSITION TO NEW PARENTHOOD IS MARKED BY DRAMATIC CHANGES IN SOCIAL ROLES AND RESPONSIBILITIES. TO SUPPORT NEW PARENTS, OBSTETRIC AND PEDIATRIC HEALTHCARE SURROUNDING THIS TRANSITION IS DESIGNED WITH A SUPPORTIVE FOCUS TO FACILITATE NEW PARENTS' NAVIGATION OF THE ATTENDANT LIFE CHANGES. THE COVID-19 PANDEMIC HAS ALTERED HEALTHCARE DELIVERY IN WAYS THAT HAVE LIMITED THESE SUPPORTIVE OBSTETRICS AND PEDIATRIC SERVICES PROVIDED AT THE BEGINNING OF NEW PARENTHOOD. CONSEQUENTLY, ASPECTS OF PREVENTATIVE HEALTHCARE, SUCH AS MONITORING FOR SYMPTOMS OF POSTPARTUM DEPRESSION, DISCUSSING OPTIMAL BIRTH CONTROL OPTIONS, EDUCATING PARENTS ON RECOMMENDED ADULT AND PEDIATRIC VACCINATIONS, AND PROVIDING ANTICIPATORY GUIDANCE ON INFANT WELLNESS, ARE LESS ROBUST. IN ADDITION, WITHOUT PROFESSIONAL GUIDANCE AND SUPPORT, OUTCOMES OF FOUNDATIONAL IMPORTANCE TO NEW PARENTS, SUCH AS PERCEIVED STRESS, DEPRESSIVE AND ANXIETY SYMPTOMS, OR PARENTING AND BREAST-FEEDING SELF-EFFICACY, ARE WORSE. MOREOVER, THE COVID-19 PANDEMIC HAS UNDERSCORED THE IMPACT OF THE SOCIAL DETERMINANTS OF HEALTH ON NEW FAMILY WELLNESS, WITH RACIAL/ETHNIC MINORITY AND LOW-INCOME FAMILIES BEING DIFFERENTIALLY IMPACTED BY COVID-19 PANDEMIC DRIVEN HEALTHCARE DELIVERY CHANGES. RECOGNIZING THE POTENTIAL FOR LONGITUDINAL CHANGES IN HEALTHCARE DELIVERY ENGENDERED BY THE COVID-19 PANDEMIC, A SCALABLE, PATIENT-CENTERED, EQUITY-FOCUSED INTERVENTION DESIGNED TO BRIDGE GAPS IN HEALTHCARE SERVICES AROUND THE TRANSITION TO NEW PARENTHOOD IS NEEDED. THIS DUE (N2H), PROJECT, “BRIDGING GAPS IN HEALTHCARE DELIVERY TO COVID-19 FOR PARENT AND INFANTS FROM BIRTH THROUGH THE FIRST YEAR OF LIFE” AIMS TO EVALUATE NURSERY2HOME A PATIENT-INFORMED DIGITAL HEALTHCARE INTERVENTION THAT S IS SPECIFICALLY RESPONSIVE TO THE COVID-19 PANDEMIC'S IMPACT ON NEW FAMILIES, WITH A FOCUS ON HEALTH EQUITY FOR RACIAL/ETHNIC MINORITY AND LOW INCOME FAMILIES. N2H BUILDS UPON PREVIOUS DIGITAL HEALTH SUCCESSES OF OUR TEAM WHILE INCORPORATING THE EVIDENCE-BASED COLLABORATIVE CARE MODEL FOR MENTAL HEALTH SUPPORT. N2H IS DESIGNED TO MITIGATE THE ADVERSE EFFECTS OF HEALTHCARE DELIVERY CHANGES IN RESPONSE TO THE COVID-19 PANDEMIC AND TO IMPROVE HEALTH FOR MOTHERS, FATHERS, AND INFANTS OVER THE FIRST YEAR OF LIFE. DEVELOPED FROM FEEDBACK GIVEN BY NEW PARENTS WHO DELIVERED DURING THE COVID-19 PANDEMIC, N2H PROVIDES 1) PARENTAL EDUCATION ABOUT THEIR OWN PHYSICAL AND MENTAL HEALTH, 2) INFANT WELLNESS RESOURCES AND TRACKING OF RECOMMENDED HEALTHCARE SERVICES, 3) PARENTAL MENTAL HEALTH SCREENING AND SUPPORT, AND 4) SYSTEMATIC CASE REVIEW TO OPTIMIZE THE HEALTH OF NEW FAMILIES. WE ASSIGNED IMPROVES IN HEALTH WILL TEST THE EFFICACY OF N2H VIA A RANDOMIZED CONTROLLE TRIAL. IN TOTAL, 640 DIVERSE FAMILIES WILL BE RANDOMLY TO EITHER USUAL CARE OR N2H INTERVENTION ARM TO EVALUATE WHETHER, COMPARED TO USUAL CARE, N2H HEALT SERVICES UTILIZATION AND PATIENT REPORTED OUTCOMES OF FOUNDATIONAL IMPORTANC TO NEW FAMILIES. ADDITION, WE WILL EVALUATE THE IMPACT OF N2H ON RACIAL/ETHNIC AND INCOME-BASED DISPARITIES OBSERVED IN BOTH SERVICES UTILIZATION AND PATIENT REPORTED OUTCOMES. D H E

NICHD MATERNAL FETAL MEDICINE UNITS NETWORK

COLLABORATIVE CARE MODEL FOR PERINATAL DEPRESSION SUPPORT SERVICES -- POPULATION-LEVEL EQUITY-CENTERED SYSTEMS CHANGE (COMPASS-PLUS): A HYBRID TYPE 2 CLUSTER RANDOMIZED TRIAL - PROJECT SUMMARY/ABSTRACT OVER 15% OF WOMEN IN THE UNITED STATES ARE IMPACTED BY DEPRESSION DURING OR AFTER PREGNANCY. UNTREATED PERINATAL DEPRESSION DRAMATICALLY IMPAIRS MATERNAL QUALITY OF LIFE AND, IN ITS MOST EXTREME FORM, CAN LEAD TO SUICIDE WHICH REMAINS A LEADING CONTRIBUTOR TO MATERNAL MORTALITY. DESPITE RECOGNITION OF ITS IMPORTANCE, MULTIPLE BARRIERS EXIST IN THE DEPRESSION CARE CASCADE. ONE OF THESE BARRIERS IS THE EXISTING HEALTH SYSTEM STRUCTURE, WHEREIN OBSTETRIC AND PSYCHIATRIC CARE EXISTS IN SILOS AND SOCIAL DETERMINANTS OF MENTAL HEALTH (SDOMH) ARE NOT SYSTEMATICALLY INTEGRATED INTO CARE PLANS. WITHOUT A SYNERGISTIC APPROACH TO THE WHOLE WOMAN, BOTH PHYSICALLY AND MENTALLY, SCREENING FOR DEPRESSIVE SYMPTOMS OCCURS INCONSISTENTLY. EVEN WHEN SCREENING OCCURS AND DEPRESSION IS DIAGNOSED, TREATMENT IS OFTEN NOT INITIATED, DEPRESSIVE SYMPTOMS ARE NOT TRACKED, AND CARE IS NOT ESCALATED WITH THE GOAL OF SYMPTOM REMISSION. THIS LACK IN COORDINATED AND PERSONALIZED CARE HAS LEFT THOUSANDS OF WOMEN VULNERABLE EACH YEAR IN THE UNITED STATES. MOREOVER, THERE ARE SIGNIFICANT INEQUITIES IN PERINATAL DEPRESSION CARE WHICH CONTRIBUTE TO THE WIDENING RACIAL AND ETHNIC DISPARITIES IN QUALITY OF LIFE, MATERNAL MORBIDITY, AND MATERNAL MORTALITY. IT IS IMPERATIVE THAT WE IDENTIFY ALTERNATIVE MECHANISMS TO ADEQUATELY IDENTIFY AND TREAT PERINATAL DEPRESSION IN AN EQUITABLE MANNER AND INCORPORATE MENTAL HEALTHCARE AS A COMPONENT OF INTERVENTIONS DESIGNED TO REDUCE MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY. THE COLLABORATIVE CARE MODEL (CCM), WHEN IMPLEMENTED IN THE PRIMARY CARE CONTEXT, LEADS TO IMPROVEMENTS IN MENTAL HEALTH OUTCOMES. HOWEVER, THE PERINATAL CONTEXT IS UNIQUE ON THE PATIENT, CLINICIAN, AND SYSTEMS LEVELS. THUS THE PERINATAL CCM (PCCM) REQUIRES ITS OWN VALIDATION. ONE SMALL (N=168), RANDOMIZED TRIAL SUGGESTS THE PCCM IS EFFICACIOUS IN REDUCING DEPRESSIVE SYMPTOMS. DESPITE THESE DATA, PCCM REMAINS RARELY UTILIZED DUE TO TWO EXISTING GAPS IN THE RESEARCH-TO-PRACTICE CONTINUUM. FIRST, THE EXISTING EFFICACY DATA LACK GENERALIZABILITY NEEDED FOR BROAD DISSEMINATION. SECOND, NO STUDIES HAVE BEEN PUBLISHED TO INFORM BEST PRACTICES WITH RESPECT TO AN IMPLEMENTATION STRATEGIES PACKAGE FOR PCCM, WITH ATTENTION TO THE UNIQUE ASPECTS OF THE PERINATAL CONTEXT. MOREOVER, WHILE THE PCCM IS AN EQUITY-CENTERED INTERVENTION, THE PERSISTENT DISPARITIES OBSERVED IN PREGNANCY OUTCOMES AND PERINATAL MENTAL HEALTH REQUIRE AN INTENTIONAL, INNOVATIVE, INCLUSIVE, ANTI-RACIST APPROACH THAT BUILDS UPON THE TRADITIONAL EQUITY-CENTERED CCM FOUNDATIONS AND CENTERS IDENTIFICATION AND MITIGATION OF SDOMH. WE WILL LEVERAGE EXISTING CLINICAL ALGORITHMS AND DATABASES DEVELOPED FOR AN ESTABLISHED AND SUCCESSFUL PCCM TO PERFORM A RIGOROUS STEPPED-WEDGE CLUSTER-RANDOMIZED TRIAL TO EVALUATE THE EFFECT OF AN EQUITY-ENHANCED PCCM [COMPASS-PLUS (COLLABORATIVE CARE MODEL FOR PERINATAL DEPRESSION SUPPORT SERVICES – POPULATION-LEVEL HEALTH EQUITY-CENTERED STRUCTURAL CHANGES)] ON MATERNAL MENTAL HEALTH OUTCOMES AND MENTAL HEALTH DISPARITIES. WE WILL OPTIMIZE AN IMPLEMENTATION STRATEGY PACKAGE TAILORED TO PERINATAL CARE VIA A HYBRID TYPE 2 IMPLEMENTATION-EFFECTIVENESS DESIGN WITH THE GOAL OF BROAD DISSEMINATION OF THE PCCM.

COMPUTERIZED INTERVENTION FOR REDUCING INTIMATE PARTNER VIOLENCE FOR PERINATAL WOMEN SEEKING MENTAL HEALTH TREATMENT

NICHD COOPERATIVE MULTICENTER NEONATAL RESEARCH NETWORK

NEUROPROTECTIVE STRATEGY: NOVEL PURINE DERIVATIVES FOR NEONATAL HYPOXIA-ISCHEMIA - PROJECT SUMMARY/ABSTRACT HYPOXIA-ISCHEMIA (HI) IS THE ONE OF LEADING CAUSES OF NEURODEVELOPMENTAL MORBIDITIES IN PRETERM AND FULL-TERM INFANTS. THE ONLY THERAPEUTIC STRATEGY TO TREAT HI ENCEPHALOPATHY (HIE) IN FULL TERM INFANTS IS HYPOTHERMIA, WHICH IS ONLY PARTIALLY PROTECTIVE. THE ONLY THERAPY FOR HI IN PRETERM INFANTS IS SUPPORTIVE CARE. HI BRAIN INJURY IS CHARACTERIZED BY A PRONOUNCED INFLAMMATORY RESPONSE ALONG WITH EARLY STRUCTURAL ALTERATIONS IN THE BLOOD-BRAIN BARRIER (BBB)/NEUROVASCULATURE UNIT (NVU). BOTH INFLAMMATION AND BBB ABNORMALITIES PREDISPOSE TO NEURONAL DAMAGE. IN THE CURRENT PROPOSAL, WE INVESTIGATE A NOVEL FAMILY OF MOLECULES, WHICH ARE PURINE DERIVATIVES (PDD), ACTING THROUGH GSK-3SS AND PROHIBITIN (PHB) PATHWAYS. PHB PROTECTS THE INTEGRITY OF OPA1 IN BRAIN MITOCHONDRIA, WHICH IS A PARTICULARLY IMPORTANT PROTECTIVE PROTEIN IN THE IMMATURE BRAIN. PREVIOUS STUDIES HAVE SHOWN THAT OPA1 PREVENTS MITOCHONDRIAL PERMEABILIZATION, RESPIRATORY DETERIORATION AND APOPTOSIS IN NEURONS AND VASCULAR BEDS. OUR PUBLISHED DATA SHOW THAT PDD I) RESCUE COGNITIVE DEFICITS ASSOCIATED WITH AGING IN MICE, II) PREVENT IMPAIRMENT OF NEUROGENESIS, III) ENHANCE SYNAPTIC FUNCTION AND IV) REDUCE NEUROINFLAMMATORY BRAIN INJURY IN ADULT MICE. GSK-3SS AND PHB SIGNALING PATHWAYS, INCLUDING NF-KSS, ARE INVOLVED IN THE NEUROPROTECTIVE MECHANISMS OF PDD. OUR PRELIMINARY RESULTS IN THE WELL-CHARACTERIZED RICE-VANNUCCI MODEL OF NEONATAL HI SHOWED THAT PDD GIVEN AFTER HI I) DECREASED IN THE HI RELATED INFARCT VOLUMES BY 40%. OUR PRELIMINARY DATA SUGGESTS PDDS EXERT I) IMPORTANT AND CONSISTENT NEUROPROTECTIVE EFFECTS IN NEONATAL AND ADULT MODELS OF BRAIN INJURY, II) INCREASED OPA-1 EXPRESSION AND III) INCREASED THE TRANSCRIPTIONAL EXPRESSION OF NEUROTROPHIC FACTORS IN TREATED FEMALE, BUT NOT MALE, NEONATAL RATS AFTER HI. THESE RESULTS SUGGEST INDUCTION OF NEURONAL PLASTICITY AND OPA-1 EXPRESSION IN THIS MODEL THAT COULD BE BENEFICIAL AFTER NEONATAL HI. THE OVERALL HYPOTHESIS OF OUR PROPOSAL IS THAT PDD TARGETS GSK-3SS AND PHB TO ATTENUATE BOTH THE BBB ABNORMALITIES AND INFLAMMATION AFTER NEONATAL HI. WE WILL TEST THIS MAJOR HYPOTHESIS IN TWO SPECIFIC AIMS: AIM 1: PDD303 ATTENUATES BRAIN INJURY IN NEONATAL RATS AFTER EXPOSURE TO MODERATE AND SEVERE HI. AIM 2: TREATMENT WITH PDD303 IMPROVES BEHAVIORAL OUTCOMES AND DEMONSTRATES DURABLE LONG-TERM NEUROPROTECTIVE EFFICACY AFTER HI IN NEONATAL SUBJECTS. WE ANTICIPATE THAT THIS INNOVATIVE THERAPEUTIC STRATEGY TARGETING THE BBB AND NEUROINFLAMMATION THROUGH GSK3SS AND PHB COULD EVENTUALLY PROVIDE AN ADDITIONAL TREATMENT STRATEGY TO THE CURRENT STANDARD OF CARE FOR BOTH FULL TERM AND PREMATURE INFANTS.

DEVELOPMENT OF AN ASSAY FOR THE EARLY DETECTION OF OVARIAN CANCER

EFFECT OF IATROGENIC DELIVERY AT 34-38 WEEKS' GESTATION ON PREGNANCY OUTCOME

CONGRESSIONALLY DIRECTED SPENDING FOR CONSTRUCTION PROJECTS - PROJECT DESCRIPTION THE GOAL OF THIS PROJECT IS TO DEVELOP A NATIONALLY ACCREDITED IN-HOSPITAL BIRTH CENTER: AN ALONGSIDE MIDWIFERY UNIT (AMU) BESIDE WOMEN AND INFANTS HOSPITAL’S (W&I) NEW LABOR AND DELIVERY CENTER. THIS DIFFERS FROM THE LABOR AND DELIVERY CENTER IN THAT IT IS A DEDICATED AND PROTECTED SPACE FOR NORMAL PHYSIOLOGIC BIRTH. THIS MODEL OF CARE IS A WELLNESS MODEL OF PREGNANCY AND BIRTH GUIDED BY THE PRINCIPLES OF PREVENTION, SENSITIVITY, SAFETY, APPROPRIATE MEDICAL INTERVENTION, AND COST EFFECTIVENESS. THE PURPOSE OF THIS NEW SERVICE IS TO PROVIDE HEALTHY BIRTHING INDIVIDUALS THE OPTION TO GIVE BIRTH IN PROTECTED, DEDICATED SPACE FOR NORMAL PHYSIOLOGIC BIRTH IN A TEAM LED BY EXPERTS IN LOW-RISK BIRTH; CERTIFIED NURSE MIDWIVES (CNM). THIS UNIQUE MODEL OF CARE HISTORICALLY AND CONSISTENTLY PROVIDES EXCELLENT PERINATAL OUTCOMES; SPECIFICALLY LOWER CESAREAN RATES, AND HIGHER BREASTFEEDING RATES THAN TRADITIONAL CARE, WHILE REDUCING THE RISKS AND COSTS OF SURGICAL BIRTH AND DECREASING HOSPITAL LENGTH OF STAY. ADDITIONALLY, THIS UNIT WOULD SERVE AS A VALUABLE INTERPROFESSIONAL TRAINING SITE FOR DOULAS, MIDWIVES, AND PRIMARY CARE PROVIDERS, MITIGATING THE STATE’S CURRENT SHORTAGE OF THESE PROFESSIONALS. W&I HAS HAD THE ONLY STATE-APPROVED IN-HOSPITAL ALTERNATIVE BIRTH CENTER (ABC) SINCE 1986, WHEN THE FACILITY WAS BUILT. IN PREPARATION FOR THE BUILDING OF A NEW LABOR AND BIRTH UNIT, A GROUP OF THE HOSPITAL MIDWIVES CONDUCTED A HISTORICAL ANALYSIS OF THE ABC TO UNDERSTAND THE INTERNAL AND EXTERNAL BARRIERS TO UTILIZATION OVER THE 35 YEARS, AS WELL AS A SWOT ANALYSIS. THEY BROUGHT TOGETHER A MULTI-STAKEHOLDER TEAM INCLUSIVE OF COMMUNITY MEMBERS TO ENVISION A LABOR AND BIRTH UNIT THAT IS SUSTAINABLE, SUPPORTIVE, COST-EFFICIENT, AND PROVIDES OPTIMAL EXPERIENCES OF CARE IN WHICH EVERY FAMILY HAS EQUITABLE AND POSITIVE OUTCOMES. THE PROCESS BROUGHT THE GROUP TO AN INNOVATIVE SOLUTION: AN ACCREDITED ALONGSIDE MIDWIFERY UNIT. KEY STAKEHOLD ERS VOICED UNANIMOUS SUPPORT FOR A PROPOSED AMU AS PART OF A NEW HOSPITAL REDESIGN. THE AMU ADDRESSES SYSTEM LEVEL CHANGE, PROTECTED SPACE FOR PHYSIOLOGIC BIRTH, AND DISPARITIES IN OUTCOMES AND EXPERIENCE OF CARE. THE DEDICATED AMU REQUIRES RENOVATING SPACES, ENVIRONMENTAL REDESIGNS, AND SPECIALIZED EQUIPMENT. THERE WILL BE 2 REDESIGNED BIRTHING ROOMS. THE ROOMS WILL BE DESIGNED FOR A HOMELIKE, NON-INSTITUTIONAL AMBIENCE: SPACIOUS CONDITIONS TO ACCOMMODATE THE BIRTHING PERSON, SUPPORT PERSONS, CARE PROVIDERS, AND STAFF; CONCEALED MEDICAL EQUIPMENT; AND SPACE AND EQUIPMENT FOR COMFORT MEASURES AND LABOR TOOLS (SHOWERS AND TUBS, REBOZO, BIRTHING BALLS). EACH ROOM WILL INCLUDE FEATURES THAT SUPPORT PHYSIOLOGIC BIRTH, SUCH AS BIRTHING TUBS. THERE WILL BE A SHARED FAMILY ROOM EASILY, ACCESSIBLE TO THE BIRTHING ROOMS, THAT INCLUDES A KITCHENETTE, A PLAY AREA FOR CHILDREN, AND CHAIRS AND SOFAS. FINALLY, THE REDESIGN WOULD INCLUDE ATTACHED WORKSPACES FOR CARE PROVIDERS AND STAFF. WITH THESE RENOVATIONS AND EQUIPMENT, THE AMU WOULD MEET ACCREDITATION REQUIREMENTS FOR THE COMMISSION FOR THE ACCREDITATION OF BIRTH CENTERS, WHICH REFLECTS THE BEST PRACTICES AND HIGHEST QUALITY OF CARE. THIS PROJECT WILL IMPROVE MATERNAL HEALTHCARE IN RHODE ISLAND, CONTRIBUTING TO HEALTHY FAMILIES ACROSS THE STATE. IN ADDITION TO PROVIDING CARE, THE AMU ADDRESSES SEVERAL WORKFORCE DEVELOPMENT ISSUES IMPORTANT TO RHODE ISLAND. FOR EXAMPLE, WE ARE PLANNING A MIDWIFERY LEARNING AND FELLOWSHIP PROGRAMS IN PARTNERSHIP WITH FRONTIER UNIVERSITY AND YALE SCHOOL OF NURSING THAT IS AIMED AT GROWING AND DIVERSIFYING RHODE ISLAND’S MIDWIFERY PROFESSIONALS. THIS WILL ADDRESS A WORKFORCE SHORTAGE OF EXPERIENCED COMMUNITY NURSE MIDWIVES, RECRUIT DIVERSE FACULTY AND CLINICIANS, PROVIDE MENTORED SUPPORT TO FACILITATE RETENTION, AND TRANSITION NEW PRACTITIONERS TO COMPLEX HEALTH PROBLEMS AND SYSTEMS IN A MANNER THAT SUPPORTS THEIR CONFIDENCE AND COMPETENCE.

NICHD COOPERATIVE MULTICENTER NEONATAL RESEARCH NETWORK

BROWN/WIH PELVIC FLOOR DISORDERS NETWORK SITE

LEVONORGESTREL INTRAUTERINE SYSTEM VERSUS ORAL CONTRACEPTIVES FOR HEAVY MENSES

NOVEL VACUUM-INDUCED POSTPARTUM HEMORRHAGE CONTROL: A MULTICENTER RANDOMIZED TRIAL. - ABSTRACT EVERY YEAR, 130 MILLION WOMEN DELIVER BABIES AROUND THE WORLD, AND AN ESTIMATED 14 MILLION EXPERIENCE POSTPARTUM HEMORRHAGE (PPH) - RECENTLY REDEFINED AS A CUMULATIVE BLOOD LOSS OF 1000 ML OR MORE OR BLOOD LOSS ASSOCIATED WITH SIGNS OR SYMPTOMS OF HYPOVOLEMIA, IRRESPECTIVE OF THE ROUTE OF DELIVERY. PPH IS THE LEADING CAUSE OF MATERNAL MORTALITY WORLDWIDE, RESPONSIBLE FOR 25% OF MATERNAL DEATHS FROM OBSTETRIC CAUSES, WITH 99% OCCURRING IN LOW AND LOWER-MIDDLE INCOME COUNTRIES (LMICS). THE MOST COMMON CAUSE OF PPH IS UTERINE ATONY - WHEN THE UTERUS FAILS TO ADEQUATELY CONTRACT AFTER CHILDBIRTH - ACCOUNTING FOR 70% OF ALL PPH. ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR, CONSISTING OF ADMINISTERING PROPHYLACTIC UTEROTONICS, CONTROLLED CORD TRACTION, AND UTERINE MASSAGE, REDUCES THE INCIDENCE OF PPH BY APPROXIMATELY 66%. WHEN PPH OCCURS IN SPITE OF THESE PREVENTIVE MEASURES, THERAPEUTIC OPTIONS INCLUDE ADDITIONAL UTEROTONICS (MEDICAL), UTERINE TAMPONADE (MECHANICAL) AND SURGICAL INTERVENTIONS (VASCULAR LIGATION, UTERINE COMPRESSION SUTURES AND HYSTERECTOMY). UTERINE BALLOON TAMPONADE IS OFTEN THE SECOND LINE THERAPY WHEN MEDICAL MANAGEMENT IS UNSUCCESSFUL AND IS ACHIEVED WITH INFLATABLE DEVICES INSERTED INTO THE UTERUS TO EXERT OUTWARD COMPRESSION ON THE UTERINE WALLS. DESPITE ITS WIDESPREAD USE, ITS MECHANISM IS COUNTERINTUITIVE TO THE PHYSIOLOGIC UTERINE CONTRACTION THAT OCCURS AFTER DELIVERY TO CONTROL BLEEDING. ITS USE IS FURTHER LIMITED BY PROLONGED TREATMENT TIMES (TYPICALLY 12-24 HOURS), URINARY TRACT OCCLUSION, AND INABILITY TO REVEAL ANY CONTINUING BLEEDING. LOW-COST OPTIONS - MOST COMMONLY CONDOM CATHETERS - ARE USED IN LMICS, BUT TWO RECENT RANDOMIZED TRIALS SHOWED NO IMPROVEMENT IN MATERNAL OUTCOMES AND POSSIBLE HARM. THUS, THERE IS AN URGENT NEED FOR EFFECTIVE AND SAFE TREATMENT OPTIONS TO REDUCE THE BURDEN OF PPH PARTICULARLY IN LMICS. THE JADA® SYSTEM IS A NOVEL FDA-CLEARED INTRAUTERINE VACUUM-INDUCED HEMORRHAGE-CONTROL DEVICE SPECIFICALLY DESIGNED FOR RAPID TREATMENT OF PPH. IT MIMICS POSTPARTUM PHYSIOLOGY BY APPLYING LOW-LEVEL INTRAUTERINE NEGATIVE PRESSURE TO FACILITATE UTERINE COMPRESSIVE FORCES FOR CONSTRICTION OF BLOOD VESSELS TO ACHIEVE HEMOSTASIS. PRELIMINARY DATA FROM TWO STUDIES HAVE SHOWN PROMISING RESULTS, BUT THESE DATA ARE LIMITED BY LACK OF CONTROL GROUPS, POSSIBLE SELECTION BIAS AND THE MODEST SAMPLE SIZES WHICH PRECLUDE DEFINITIVE CONCLUSIONS REGARDING THE RELATIVE EFFECTIVENESS AND SAFETY OF THE JADA® SYSTEM. WE PROPOSE THE FIRST DEFINITIVE, RANDOMIZED CONTROL TRIAL TO TEST THE HYPOTHESIS THAT THE JADA® SYSTEM IS EFFECTIVE, SAFE AND COST-EFFECTIVE IN TREATING PPH, COMPARED TO STANDARD CARE. A MULTIDISCIPLINARY TEAM OF INVESTIGATORS WITH EXPERTISE IN OBSTETRICS, GLOBAL HEALTH AND CLINICAL TRIALS WILL ENROLL 424 WOMEN IN TWO HIGH VOLUME OBSTETRIC UNITS IN GHANA, A LMIC WITH HIGH PPH BURDEN, TO EVALUATE THE EFFECTIVENESS (PRIMARY AIM), 2) SAFETY (SECONDARY AIM 1), AND 3) COST-EFFECTIVENESS (SECONDARY AIM 2) OF THE JADA® SYSTEM, COMPARED TO STANDARD CARE, IN TREATING PPH.

PRENATAL METHAMPHETAMINE EXPOSURE AND CHILD DEVELOPMENT IN NEW ZEALAND AND USA

EFFECT OF A TECHNOLOGY-BASED COLLABORATIVE CARE MODEL ON PERSISTENT HYPERTENSION AND PREVENTIVE CAREATTENDANCE AMONG POSTPARTUM PEOPLE WITH HYPERTENSIVE DISORDERS OF PREGNANCY - PROJECT SUMMARY/ABSTRACT UNCONTROLLED HYPERTENSIVE DISORDERS OF PREGNANCY (HDP) ARE A MAJOR SOURCE OF MATERNAL MORTALITY. NATIONAL GUIDELINES RECOMMEND BLOOD PRESSURE (BP) MEASUREMENT 3–10 DAYS AFTER DISCHARGE AND ≥1 PREVENTIVE CARE VISIT WITHIN ONE YEAR OF DELIVERY. YET, BARRIERS SUCH AS CHILDCARE OR TRANSPORTATION ISSUES REDUCE ADHERENCE TO IN- PERSON BP CHECKS, PARTICULARLY AMONG RACIAL OR ETHNIC MINORITY PATIENTS. PROGRAMS IN WHICH PATIENTS SELF- MEASURE BP (SMBP) AT HOME SHOW PROMISING RESULTS REGARDLESS OF PATIENT RACE. HOWEVER, A RECENT META- ANALYSIS CONCLUDED CURRENT SMBP PROGRAMS DO NOT REDUCE MATERNAL MORTALITY OR RACIAL DISPARITIES IN CLINICAL OUTCOMES, POTENTIALLY DUE TO THEIR SPECIFIC LIMITATIONS: THEY END WITHIN SIX WEEKS OF BIRTH (THOUGH HDP CAN PERSIST FOR MONTHS) AND HAVE DECREASED ENGAGEMENT WITH NON-WHITE PEOPLE OR THOSE LIVING IN DISADVANTAGED AREAS, THOUGH THESE POPULATIONS ARE AT THE HIGHEST RISK OF PERSISTENT HTN AND ITS ADVERSE LONG-TERM EFFECTS. THUS, THERE IS AN URGENT NEED TO OPTIMIZE SMBP PROGRAMS TO TARGET SHORT- AND LONG-TERM HDP-RELATED MORBIDITY AND TO BROADLY IMPLEMENT THESE PROGRAMS TO ELIMINATE DISPARITIES IN HDP-RELATED OUTCOMES. ONE SUCH PROGRAM IS RHODE ISLAND (RI)-STATEWIDE POSTPARTUM HYPERTENSION REMOTE SURVEILLANCE (RI-SPHERES), A TECHNOLOGY-BASED SMBP PROGRAM THAT AIMS TO REDUCE SHORT- AND LONG-TERM HDP-ASSOCIATED MORBIDITY IN RI USING THE COLLABORATIVE CARE MODEL, A HEALTH SERVICES INTERVENTION THAT IMPROVES HEALTH OUTCOMES AND REDUCES RACIAL DISPARITIES ON A POPULATION LEVEL FOR PEOPLE WITH CHRONIC CONDITIONS. THE PROPOSED RESEARCH AIMS TO DETERMINE THE EFFECTIVENESS OF RI-SPHERES IN REDUCING SHORT- AND LONG-TERM MORBIDITY ASSOCIATED WITH HDP THROUGHOUT RI. THIS BUILDS UPON OUR PILOT RCT (NCT05595629), IN WHICH A STANDARD SMBP PROGRAM WAS COMPARED TO A SMBP PROGRAM THAT USED A BLUETOOTH-ENABLED BP CUFF THAT SYNCS TO A SMARTPHONE APPLICATION (APP) TO SEND AUTOMATED REMINDERS AND PROVIDE ADAPTIVE MESSAGING TAILORED TO DISTINCT BP VALUES AND SYMPTOMS. RI-SPHERES WILL EXPAND THIS SMBP PROGRAM TO PROVIDE APP-BASED PATIENT-INFORMED EDUCATIONAL CONTENT ON HDP-SPECIFIC PREVENTIVE CARE AND BIDIRECTIONAL COMMUNICATION WITH RI-SPHERES STAFF FOR ONE YEAR POSTPARTUM. INCORPORATING ADAPTIVE AND AUTOMATIC MESSAGING INCREASES RI-SPHERES’ SCALABILITY BY REDUCING CLINICAL STAFF BURDEN. HOWEVER, FORMAL ANALYSIS OF FACTORS THAT MAY HINDER WIDESPREAD IMPLEMENTATION OF RI- SPHERES IS NEEDED. THUS, WE WILL CONDUCT A HYBRID TYPE I NON-INFERIORITY IMPLEMENTATION-EFFECTIVENESS TRIAL AMONG 1,536 PATIENTS WITH HDP THAT COMPARES A STANDARD SMBP PROGRAM TO RI-SPHERES IN TERMS OF PERSISTENT HTN AT SIX WEEKS POSTPARTUM AND RECEIPT OF PREVENTIVE CARE WITHIN ONE YEAR OF DELIVERY. WE WILL ALSO DEVELOP AN IMPLEMENTATION TOOLKIT TO FACILITATE THE DISSEMINATION OF RI-SPHERES. THE PROPOSED PROJECT IS EXPECTED TO DELIVER A MECHANISM THAT WILL FILL MULTIPLE RESEARCH GAPS FOR HDP IDENTIFIED BY THE US PREVENTIVE SERVICES TASK FORCE: 1) ADDRESSING HEALTH INEQUITIES THROUGH MULTILEVEL INTERVENTIONS, 2) EVALUATING SMBP PROGRAMS; AND 3) MITIGATING HDP’S SHORT- AND LONG-TERM HEALTH CONSEQUENCES OF HDP.

A RANDOMIZED TRIAL OF CHATBOT FOR PRENATAL GENETIC COUNSELING - PROJECT SUMMARY CURRENT RECOMMENDATIONS FROM THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS (ACOG) CALL FOR ALL PREGNANT PEOPLE TO BE OFFERED SCREENING AND DIAGNOSTIC TESTING OPTIONS FOR ANEUPLOIDY AND CARRIER SCREENING FOR CYSTIC FIBROSIS AND SPINAL MUSCULAR ATROPHY. AS A RESULT, THE NEARLY 4 MILLION PREGNANT PEOPLE RECEIVING PRENATAL CARE IN THE UNITED STATES ANNUALLY REQUIRE ACCESS TO THE ASSOCIATED, AND COMPLEX, PRENATAL GENETIC COUNSELING. WITH THESE CONSIDERATIONS AND A COMMITMENT TO PERSON CENTERED-CARE, INFORMED DECISION-MAKING IS CRITICAL, AND PREDICATED ON PEOPLE HAVING ADEQUATE KNOWLEDGE OF THE BENEFITS AND RISKS OF DIFFERENT TESTING OPTIONS. OBSTETRIC CARE PROVIDERS HAVE THE CHALLENGE OF ADDRESSING AN EVER-INCREASING NUMBER OF TOPICS DURING THE FIRST PRENATAL CARE VISIT, AND PRENATAL GENETIC COUNSELORS FACE A HIGH NUMBER OF REFERRALS. YET THERE IS A NATIONAL SHORTAGE OF GENETIC COUNSELORS WITH AN UNEVEN GEOGRAPHIC DISTRIBUTION. THE RESULTING LACK OF ACCESS TO STANDARDIZED PRENATAL GENETIC COUNSELING CAN LEAD TO PATIENT MISINTERPRETATION OF THE GOALS OR RESULTS OF PRENATAL GENETIC TESTING AND MAY BE CONTRIBUTING TO SOCIOECONOMIC AND RACIAL DISPARITIES IN PRENATAL GENETIC SCREENING AND DIAGNOSIS. LANGUAGE BARRIERS FURTHER EXACERBATE MISUNDERSTANDING OF PRENATAL GENETIC TESTING OPTIONS. MOBILE DIGITAL TOOLS, INCLUDING CHATBOTS, PROVIDE AN ATTRACTIVE ALTERNATIVE TO IN-PERSON GENETIC COUNSELING DUE TO THE NEAR UBIQUITOUS AVAILABILITY OF MOBILE DEVICES AMONG PATIENTS AND ABILITY TO ENSURE TAILORING AND STANDARDIZATION. PREVIOUS DIGITAL TOOLS DEVELOPED FOR PRENATAL GENETIC EDUCATION SHOWED PROMISE, BUT MOST ARE INSTRUCTIONAL THAN INTERACTIVE, COMPUTER-BASED RATHER THAN MOBILE-BASED, AND DO NOT INCLUDE INFORMATION ON CARRIER SCREENING CURRENTLY RECOMMENDED BY ACOG. TO ADDRESS THIS CRITICAL NEED, A MULTIDISCIPLINARY TEAM OF PERINATOLOGISTS, GENETIC COUNSELORS, AND DIGITAL HEALTH EXPERTS DEVELOPED AN INNOVATIVE, PATIENT-INFORMED, MOBILE CHATBOT (IPRENATAL) TO SIMULATE A TEXT AND AUDIO-BASED COUNSELING DISCUSSION ABOUT ANEUPLOIDY SCREENING AND DIAGNOSIS. PRELIMINARY DATA FROM OUR RANDOMIZED TRIAL OF 258 ENGLISH-SPEAKING PREGNANT PEOPLE SHOWED SIGNIFICANTLY HIGHER POST- INTERVENTION KNOWLEDGE SCORES AMONG PATIENTS WHO USED IPRENATAL COMPARED WITH THOSE WHO RECEIVED ROUTINE PROVIDER EDUCATION. WE NOW PROPOSE TO LEVERAGE THIS SUCCESS BY ENGAGING USERS IN FORMATIVE WORK TO CREATE IPRENATAL+ AND PROVIDE ALL CONTENT IN ENGLISH AND SPANISH. WE WILL EVALUATE IPRENATAL+ IN A RANDOMIZED CONTROLLED TRIAL OF 1,470 PREGNANT PEOPLE IN CLINICS SERVING RACIALLY AND SOCIOECONOMICALLY DIVERSE PREGNANT WOMEN. OUR SPECIFIC AIMS ARE: UTILIZE HUMAN CENTERED DESIGN TO TRANSFORM IPRENATAL TO AN ENHANCED DIGITAL EDUCATIONAL CHATBOT (IPRENATAL+) FOR PRENATAL GENETIC COUNSELING (AIM 1), DETERMINE THE EFFECT OF IPRENATAL+ ON PATIENT KNOWLEDGE AND UPTAKE OF PRENATAL GENETIC TESTING, COMPARED TO IN-PERSON GENETIC COUNSELING (AIM 2), AND ASSESS ABILITY OF IPRENATAL+ TO NARROW THE GAP IN KNOWLEDGE AND UPTAKE OF PRENATAL GENETIC SCREENING BETWEEN ENGLISH- AND SPANISH-SPEAKING PATIENTS, COMPARED TO IN PERSON GENETIC COUNSELING (AIM 3).

PLACEBO CONTROLLED TRIAL OF SERTRALINE AND IPT FOR POSTPARTUM DEPRESSION

COBRE FOR PERINATAL BIOLOGY

MECHANOTRANSDUCTION AND LUNG ALVEOLAR DIFFERENTIATION

REQUIREMENT FOR UBIQUITIN C-TERMINAL HYDROLASE FUNCTION IN MAMMALIAN OVARIAN HEALTH AND FERTILITY - PROJECT SUMMARY APPROXIMATELY 20% OF REPRODUCTIVE AGE WOMEN ARE AFFECTED BY INFERTILITY, WITH A SHOCKING ONE THIRD OF ALL CASES CONSIDERING IDIOPATHIC, OR “UNEXPLAINED”. DIMINISHED FUNCTION OF THE MAMMALIAN OVARIAN RESERVE IS ONE POTENTIAL CAUSE OF INFERTILITY, AS IT IS A FINITE AND NON-RENEWABLE POPULATION OF THE FEMALE GAMETES (“OOCYTES”) REPRESENTING THE ENTIRE REPRODUCTIVE CAPACITY OF A FEMALE. THESE CELLS ALSO SUPPORT THE ENDOCRINE FUNCTION OF THE OVARY, WITH THEIR PREMATURE DEPLETION RESULTING IN AN INABILITY TO CONCEIVE, AS WELL AS OTHER FEATURES OF AGING INCLUDING AN INCREASED RISK OF ISCHEMIA, AND OVERALL SHORTER LIFESPAN. THEREFORE, UNDERSTANDING AND PRESERVING THIS ESSENTIAL POPULATION IS CRITICAL FOR FEMALE FERTILITY, LONGEVITY AND QUALITY OF LIFE. THE GOALS OF THIS PROPOSAL ARE FOUNDED UPON OUR SINGLE CELL SEQUENCING WORK ELUCIDATING NOVEL REGULATORS OF OVARIAN RESERVE ESTABLISHMENT. WE IDENTIFIED DEUBIQUITINATING ENZYME UBIQUITIN C-TERMINAL HYDROLASE-L1 (UCHL1) AS HIGHLY ENRICHED IN MOUSE AND HUMAN OOCYTES DURING OVARIAN RESERVE FORMATION, EVENTUALLY ACHIEVING A STEADY-STATE LEVEL OF EXPRESSION THROUGH LATER-STAGE FOLLICLE DEVELOPMENT. FURTHERMORE, WE CAN DETECT AND MEASURE SECRETED UCHL1 IN MOUSE AND HUMAN SERUM, AS WELL AS HUMAN FOLLICULAR FLUID, SUGGESTING ADDITIONAL PARACRINE AND ENDOCRINE SIGNALING ROLES FOR UCHL1. INDEED, FEMALE MICE THAT LACK UCHL1 EXPRESSION ARE SEVERELY SUB-FERTILE, WITH MORPHOLOGICALLY ABNORMAL OOCYTES, DEFECTS IN FOLLICULOGENESIS, AND APPARENT SYSTEMIC ENDOCRINE DYSFUNCTION. OUR PRELIMINARY DATA ALSO SUGGEST DEFICITS IN THE ABILITY OF UCHL1 DEFICIENT OOCYTES TO PROPERLY FORM THE ZONA PELLUCIDA AND EXPRESS GAP JUNCTION PROTEINS. THEREFORE, WE HYPOTHESIZE THAT UCHL1 IS REQUIRED FOR OOCYTE QUALITY VIA REGULATION OF ZONA PELLUCIDA PROTEIN TURNOVER AND ASSEMBLY, AND THEREFORE OOCYTE-GRANULOSA CELL COMMUNICATION AS WELL AS SYSTEMIC ENDOCRINE FUNCTION. THIS PROPOSAL VASTLY EXPANDS UPON OUR INITIAL WORK TO CHARACTERIZE THE ROLE OF UCHL1 IN MAINTAINING OOCYTE QUALITY AS WELL IN REGULATING OVARIAN PROTEOSTASIS AND UBIQUITIN DYNAMICS (AIM 1). WE WILL ALSO ELUCIDATE THE TISSUE-SPECIFIC ROLES OF UCHL1, INCLUDING HOW OOCYTE-SPECIFIC UCHL1 AFFECTS OVARIAN DEVELOPMENT, REPRODUCTIVE LIFESPAN AND MAY ACT IN A PARACRINE MANNER TO PROMOTE OVARIAN SOMATIC CELL HEALTH AND OVERALL ENDOCRINE FUNCTION (AIM 2). THESE STUDIES WILL ACHIEVE THREE GOALS: 1) DETERMINE THE ROLE OF UCHL1 IN MAINTAINING OOCYTE QUALITY THROUGH REGULATION OF ZONA PELLUCIDA AND GAP JUNCTION FORMATION 2) COMPREHENSIVELY TEST THE EFFECTS OF OOCYTE-SPECIFIC UCHL1 LOSS ON GRANULOSA CELL HEALTH AND SYSTEMIC ENDOCRINE FUNCTION, AND 3) CONCLUSIVELY ELUCIDATE THE ROLE OF OOCYTE-EXPRESSED UCHL1 IN REGULATING FEMALE REPRODUCTIVE LIFESPAN, OOCYTE AND GRANULOSA CELL PROTEOSTASIS, AND OVARIAN GENE EXPRESSION PROGRAMS. THIS PROPOSAL WILL NOT ONLY HELP US BETTER UNDERSTAND THE UNIQUE OOCYTE- AND GRANULOSA-CELL-SPECIFIC FUNCTIONS OF POTENTIALLY MASTER REGULATOR OF OVARIAN FUNCTION, UCHL1, BUT ALSO WILL HELP US REFINE OUR UNDERSTANDING OF THE CRITICAL ROLES OF PROTEOSTASIS IN FEMALE REPRODUCTIVE HEALTH, AS WELL AS THE INTERDEPENDENCE BETWEEN OVERALL OVARIAN HEALTH AND OOCYTE QUALITY.

DEPRESSION PREVENTION FOR POOR PREGNANT WOMEN

ADDRESSING THE HEALTH CONCERNS OF VA WOMEN WITH SEXUAL TRAUMA

LONGITUDINAL ANTECEDENTS OF ATTENTION PROBLEMS IN VERY PRETERM CHILDREN: ROLE OF EPIGENETICS, EXECUTIVE FUNCTION, AND CAREGIVER PSYCHOLOGICAL DISTRESS - PROJECT SUMMARY/ABSTRACT THIS K01 PROPOSAL WILL PREPARE THE CANDIDATE FOR AN INDEPENDENT RESEARCH CAREER STUDYING ENVIRONMENTAL AND BIOLOGICAL CONTRIBUTORS TO CHILD NEURODEVELOPMENTAL TRAJECTORIES IN TYPICALLY-DEVELOPING AND HIGH-RISK POPULATIONS, WITH SPECIFIC EXPERTISE IN HUMAN DEVELOPMENTAL BEHAVIORAL EPIGENETICS AND CLINICALLY-RELEVANT COGNITIVE PHENOTYPES (E.G., INATTENTION). RESEARCH IN DEVELOPMENTAL PSYCHOPATHOLOGY HAS BEEN SUCCESSFUL IN IDENTIFYING RISK FACTORS FOR ATTENTION PROBLEMS ACROSS MULTIPLE DOMAINS, INCLUDING BIOLOGICAL, COGNITIVE, AND CAREGIVING FACTORS. HOWEVER, A MISSED OPPORTUNITY IS THE STUDY OF MULTIPLE, LONGITUDINAL TRAJECTORIES OF RISK FACTORS IN RELATION TO TRAJECTORIES OF INATTENTION. SPECIFICALLY, THERE IS A NEED TO UNDERSTAND WHETHER THERE ARE HETEROGENEOUS TRAJECTORIES OF INATTENTION IN EARLY CHILDHOOD, PARTICULARLY DURING THE TRANSITION TO FORMAL SCHOOLING (AGE 5-7) WHEN INCREASES IN INATTENTION ARE COMMON. FURTHER, UNDERSTANDING HOW CHANGES IN RISK FACTORS ACROSS EARLY CHILDHOOD RELATE TO CHANGES IN INATTENTION ACROSS THE TRANSITION TO FORMAL SCHOOLING COULD PROVIDE CRITICAL INFORMATION REGARDING MODIFIABLE TARGETS AND OPTIMAL TIMING FOR SCREENING AND INTERVENING WITH HIGH-RISK CHILDREN. THE PROPOSED STUDY WILL LEVERAGE EXISTING DATA FROM TWO PARENT GRANTS (R01HD072267; R01HD084515; NOVI STUDY) FOCUSED ON NEURODEVELOPMENTAL OUTCOMES IN CHILDREN BORN VERY PRETERM. THE CURRENT STUDY PROPOSES TO TEST ASSOCIATIONS BETWEEN TRAJECTORIES OF BIOLOGICAL (I.E., DNA METHYLATION), COGNITIVE (I.E., EXECUTIVE FUNCTION) AND CAREGIVING (I.E., PSYCHOLOGICAL DISTRESS) FACTORS AND TRAJECTORIES OF CHILD INATTENTION IN A SAMPLE OF CHILDREN BORN VERY PRETERM, A GROUP KNOWN TO BE AT ELEVATED RISK FOR ATTENTION PROBLEMS. SPECIFIC AIMS ARE AS FOLLOWS: (1) TO CHARACTERIZE TRAJECTORIES OF INATTENTION IN VERY PRETERM CHILDREN; (2) TO TEST THE CONTRIBUTIONS OF BIOLOGICAL, COGNITIVE, AND CAREGIVING FACTORS TO TRAJECTORIES OF INATTENTION; AND (3) TO TEST HOW CHANGES IN BIOLOGICAL, COGNITIVE, AND CAREGIVING FACTORS RELATE TO TRAJECTORIES OF INATTENTION. THE APPLICANT’S MENTORSHIP TEAM WILL SCAFFOLD COMPLETION OF THE STUDY AIMS AND PROVIDE NEEDED TRAINING IN (1) PROCESSING AND (2) ANALYSIS OF HIGH-DIMENSIONAL, LONGITUDINAL EPIGENETIC DATA, (3) ADVANCED STATISTICAL TECHNIQUES FOR LONGITUDINAL DATA ANALYSIS, AND (4) FRAMEWORKS (E.G., RDOC) FOR STUDYING CHILD PSYCHOPATHOLOGY. THE RESOURCES AND INTELLECTUAL ENVIRONMENT AT THE BROWN CENTER FOR THE STUDY OF CHILDREN AT RISK, WOMEN AND INFANT’S HOSPITAL, AND WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY CONSTITUTE AN IDEAL SETTING TO LAUNCH AN INDEPENDENT RESEARCH CAREER. THIS PROJECT WILL PROVIDE PRELIMINARY DATA FOR A FUTURE R01 INVESTIGATING HOW TRAJECTORIES OF DNA METHYLATION ARE ESTABLISHED AND ALTERED ACROSS DEVELOPMENT (E.G., AS A FUNCTION OF ENVIRONMENTAL RISK FACTORS) AS WELL AS GRANTS THAT FOLLOW NOVI CHILDREN INTO LATER CHILDHOOD. THIS PROJECT IS ALIGNED WITH NIMH STRATEGIC PRIORITIES GIVEN ITS FOCUS ON CHARTING THE DEVELOPMENT OF INATTENTION IN CHILDHOOD, IDENTIFYING RISK FACTORS AND BIOMARKERS FOR INATTENTION THAT COULD SERVE AS NOVEL INTERVENTION TARGETS, AND ISOLATING SENSITIVE PERIODS FOR INTERVENTIONS AIMED AT MITIGATING LONG-TERM FUNCTIONAL IMPAIRMENT.

A MODEL STATEWIDE TRIAL TO DETECT AND TREAT MATERNAL HYPOTHYROIDISM IN PREGNANCY

A NOVEL APP-BASED COGNITIVE BEHAVIORAL THERAPY INTERVENTION FOR PREVENTING POSTPARTUM DEPRESSION - THE PREVALENCE OF DEPRESSION IS HIGH AFTER CHILDBIRTH: RATES OF POSTPARTUM DEPRESSION (PPD) ARE AS HIGH AS 25% AMONG WOMEN WITHOUT PRIOR PPD OR DEPRESSION BUT WITH PERSONAL OR STRUCTURAL RISK FACTORS SUCH AS BEING LOW- INCOME OR A WOMEN OF COLOR, AMONG OTHERS. AS SUCH, THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS RECOMMENDS SCREENING WOMEN FOR PPD. HOWEVER, DISPARITIES IN POSTPARTUM MENTAL HEALTH CARE EXIST: <60% OF WOMEN ATTEND POST-PARTUM VISITS WHERE PPD SCREENING OCCURS, AND BARRIERS SUCH AS LACK OF TRANSPORTATION OR CHILDCARE HAVE BEEN SHOWN TO NOT ONLY REDUCE RATES OF POSTPARTUM VISIT ATTENDANCE BUT TO DISPROPORTIONATELY AFFECT LOW-INCOME WOMEN OR WOMEN OF COLOR. IN ADDITION, THE RISK OF PPD EXTENDS BEYOND 60 DAYS POST-PARTUM, WHEN PREGNANCY-RELATED FEDERAL HEALTH INSURANCE OFTEN EXPIRES. SMARTPHONE APPLICATIONS (APPS) MAY INCREASE EQUITY IN POSTPARTUM MENTAL HEALTH BY PROVIDING LONG-TERM ACCESS TO MENTAL HEALTH TREATMENT TO MOST WOMEN. INDEED, IN THE UNITED STATES, 96% OF THOSE AGED 18-29 OWN A SMARTPHONE, AND MEDICAL APPS HAVE BEEN SHOWN TO IMPROVE OBSTETRIC OUTCOMES AND INCREASE ACCESS TO MENTAL HEALTH SERVICES. THOUGH IN-PERSON, COGNITIVE BEHAVIORAL THERAPY GIVEN THROUGH THE MOTHERS AND BABIES PROGRAM (MB) HAS BEEN SHOWN TO REDUCE PPD BY 53% AMONG LOW-INCOME WOMEN OF COLOR, THE EFFECT OF APP-PROVIDED GROUP MB IS UNCLEAR. THE PURPOSE OF THIS MENTORED PATIENT-ORIENTED CAREER DEVELOPMENT AWARD (K23) IS TO ENABLE THE CANDIDATE TO DEVELOP A FUNDED RESEARCH PROGRAM TO OPTIMIZE POSTPARTUM MENTAL HEALTH CARE FOR LOW-INCOME WOMEN OF COLOR VIA AN INNOVATIVE TECHNOLOGY-BASED INTERVENTION THAT MAY DECREASE THEIR RATES OF PPD. TO ACHIEVE THIS GOAL, TRAINING AND MENTOR- SHIP ARE PROPOSED IN THREE KEY AREAS: 1) ADVANCED TRAINING IN MIXED METHODS RESEARCH, PERINATAL PSYCHOLOGY, DIGITAL HEALTH, AND BIOSTATISTICS; 2) MENTORSHIP FROM A MULTI-DISCIPLINARY TEAM OF ESTABLISHED RESEARCHERS; AND 3) PROTECTED TIME TO PERFORM PATIENT-ORIENTED RESEARCH ON THE FEASIBILITY OF UTILIZING APP-PROVIDED MB AS A STUDY INTERVENTION FOR LOW-INCOME WOMEN OF COLOR WITH RISK FACTORS FOR PPD. TWO STUDY PHASES ARE REQUIRED. FIRST, FOCUS GROUPS AND INTERVIEWS WILL OPTIMIZE THE STUDY INTERVENTION, WHICH CONTAINS MB AND PARENTING EDUCATION (PE). THOSE IN THE INTERVENTION GROUP WILL ACCESS MB+PE WHILE THOSE IN THE CONTROL GROUP WILL ACCESS PE TO ENCOURAGE APP ENGAGEMENT WITH BOTH STUDY GROUPS. THIS IS BECAUSE WOMEN IN BOTH GROUPS WILL RECEIVE BIMONTHLY EDINBURGH POSTNATAL DEPRESSION SCALES (EPDS) SCORES FROM BIRTH TO SIX MONTHS POSTPARTUM. THE PRIMARY OUTCOME OF THE PROPOSED RANDOMIZED TRIAL IS DEMONSTRATED FEASIBILITY AND ACCEPTABILITY OF APP-BASED MB, DEFINED VIA RECRUITMENT AND APP USAGE (FEASIBILITY), AND SCORES ON THE SYSTEM USABILITY SCALE AND CLIENT SATISFACTION QUESTIONNAIRE (ACCEPTABILITY). SECONDARY OUTCOMES INCLUDE EDPS SCORES. THE PROPOSED TRIAL WILL PROVIDE CRITICAL INSIGHT INTO A SUBSEQUENT R01-SUPPORTED RANDOMIZED TRIAL DESIGNED TO EXAMINE THE EFFECT OF APP-BASED MB ON PPD AMONG LOW-INCOME, RACIALLY AND ETHNICALLY DIVERSE WOMEN. IF EFFECTIVE, APP-BASED MB HAS GREAT POTENTIAL FOR SCALABILITY AND COULD INCREASE POSTPARTUM MENTAL HEALTH EQUITY FOR MOST WOMEN.

JUGGLING ROLES: A STUDY OF DIVERSE NEONATAL INTENSIVE CARE UNIT PARENTS AND THEIR WORK-FAMILY TRANSITION - PROJECT SUMMARY / ABSTRACT PRETERM INFANTS ARE AT A HEIGHTENED RISK FOR DEVELOPING NEUROMOTOR, COGNITIVE, AND PSYCHIATRIC DISORDERS THAT PERSIST THROUGH ADULTHOOD. INFANTS BORN VERY PRETERM (<32 WEEKS GESTATIONAL AGE) ARE THREE TIMES MORE LIKELY TO DEVELOP PSYCHIATRIC DISORDERS, INCLUDING ANXIETY, ADHD, AND AUTISM COMPARED TO TERM INFANTS. CRITICALLY, THE CONSEQUENCES OF PREMATURITY DISPROPORTIONATELY IMPACT BLACK AND LOW SES FAMILIES. THE OVERALL HIGH PREVALENCE OF PREMATURITY, COUPLED WITH BLACK AND LOW SES FAMILIES’ INCREASED RISK, IS A SERIOUS PUBLIC HEALTH CONCERN. HOWEVER, THE MECHANISMS CONTRIBUTING TO THESE DISPARITIES ARE LARGELY UNEXPLORED. IDENTIFYING MODIFIABLE MECHANISMS WILL HELP INFORM POLICIES AND PRACTICES THAT PROMOTE HEALTHY NEURODEVELOPMENT FOR PRETERM INFANTS AND THEIR CAREGIVERS. PARENTING PREMATURE INFANTS IS CHALLENGING DUE TO THE PHYSICAL PARENT-INFANT SEPARATION IN THE NEONATAL INTENSIVE CARE UNIT (NICU). EXTENSIVE RESEARCH HAS EMPHASIZED THE IMPORTANT ROLE OF PARENTS AND PARENTAL INVOLVEMENT IN THE NICU TO PROMOTE INFANT NEURODEVELOPMENT. YET WE KNOW LITTLE ABOUT THE EXTERNAL CONTEXTUAL FACTORS THAT IMPACT AND IMPEDE PARENT INVOLVEMENT, ESPECIALLY IN DIVERSE POPULATIONS. A SIGNIFICANT BARRIER TO NICU INVOLVEMENT MAY BE CONFLICTING WORK AND FAMILY DEMANDS. >62% OF FAMILIES WITH CHILDREN INCLUDE TWO WORKING PARENTS. FURTHER, LOW-INCOME FAMILIES IN PARTICULAR RETURN TO PAID WORK AS SOON AS FOUR WEEKS AFTER CHILDBIRTH WHICH CAN HAVE IMPLICATIONS FOR THEIR ABILITY TO VISIT THE NICU. REGRETTABLY THERE IS VIRTUALLY NO RESEARCH ON NICU PARENTS TRANSITION TO PARENTHOOD FROM A WORK-FAMILY LENS. THE PROPOSED STUDY WILL USE A UNIQUE METHOD, ECOLOGICAL MOMENTARY ASSESSMENT (EMA), TO MONITOR PARENTS’ DAILY MENTAL HEALTH, NICU INVOLVEMENT, AND WORK/FAMILY DEMANDS DURING THEIR INFANTS’ NICU HOSPITALIZATION IN A RACIALLY AND ETHNICALLY DIVERSE SAMPLE OF 250 FAMILIES (DEFINED AS A MOTHER, A SECONDARY CAREGIVER, AND THEIR INFANT). WE AIM TO 1) EXAMINE STABLE AND DYNAMIC ASSOCIATIONS BETWEEN WORK FACTORS, NICU INVOLVEMENT, AND CAREGIVER MENTAL HEALTH UTILIZING A LONGITUDINAL EMA BURST DESIGN; AND 2) EXAMINE HOW WORK, NICU INVOLVEMENT, AND CAREGIVER MENTAL HEALTH ARE RELATED TO INFANT NEURODEVELOPMENT. WE HYPOTHESIZE THAT CAREGIVERS WITH IDEAL WORK POLICIES AND CONDITIONS (E.G., SHORTER WORK HOURS, MORE JOB FLEXIBILITY, MORE JOB AUTONOMY, MORE PAID LEAVE) WILL HAVE BETTER MENTAL HEALTH AND MORE NICU INVOLVEMENT, WHICH, IN TURN, WILL BE ASSOCIATED WITH BETTER INFANT NEURODEVELOPMENTAL OUTCOMES AT NICU DISCHARGE AND 1-YEAR FOLLOW-UP. ADDITIONALLY, GIVEN THE DIFFERENTIAL NICU EXPERIENCE FOR BLACK AND LOW SES FAMILIES, WE HYPOTHESIZE THAT THE ASSOCIATIONS BETWEEN WORK, MENTAL HEALTH, NICU INVOLVEMENT, AND INFANT NEURODEVELOPMENT WILL BE EXACERBATED FOR BLACK AND LOW SES FAMILIES. RESULTS FROM THIS STUDY WILL ADDRESS THE IMPORTANT PUBLIC HEALTH CONCERN OF PREMATURITY IN DIVERSE FAMILIES FROM A UNIQUE WORK-FAMILY LENS THAT MAY HELP IDENTIFY FAMILY-LEVEL AND STATE/FEDERAL POLICY-LEVEL INTERVENTION TARGETS TO SUPPORT PARENT NICU INVOLVEMENT AND MITIGATE THE LONG-TERM NEURODEVELOPMENTAL CONSEQUENCES OF PREMATURITY.

PLACENTAL DEVELOPMENT IN FETAL ALCOHOL SYNDROME

INTERVENTIONS FOR FINANCIALLY DISADVANTAGED MOTHERS

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

A COMPREHENSIVE PATIENT BASED OUTCOME MEASURE FOR HEAVY MENSTRAL BLEEDING

GENERALIZING TESTPILOT

PATIENT-REPORTED OUTCOMES IN FUNCTIONING FOR FEMALE PELVIC FLOOR DISORDERS

THE ROLE OF MUCOSAL IMMUNITY IN THE RISK OF HIV-1 ACQUISITION DURING PREGNANCY

COMPUTER-BASED INTERVENTION FOR BATTERED SHELTERED WOMEN WITH SUBSTANCE USE

SOBER NETWORK IPT FOR PERINATAL WOMEN WITH COMORBID SUBSTANCE USE AND DEPRESSION

NEUROBIOBEHAVIORAL UNDERPINNINGS OF INTERGENERATIONAL OBESITY - ABSTRACT MATERNAL OBESITY IS A MAJOR PUBLIC HEALTH PROBLEM AFFECTING 20 MILLION WOMEN IN THE UNITED STATES AND ACCOUNTING FOR 22 TO 42% OF THE PREVALENCE OF CHILDHOOD OBESITY. CURRENTLY, 1 IN 8 CHILDREN AGED 2-5 YEARS OLD HAVE OBESITY, INCREASING THEIR RISK FOR OBESITY AND CHRONIC DISEASE DURING THE LIFECOURSE. RODENT AND NON-HUMAN PRIMATE MODELS DEMONSTRATE THAT IN UTERO EXPOSURE TO MATERNAL OBESITY AND HIGH-FAT DIET CAN ALTER FETAL DEVELOPMENT OF MESOCORTICOLIMBIC CIRCUITRIES THAT REGULATE INHIBITORY CONTROL AND REWARD SENSIVITY, LEADING TO OBESOGENIC BEHAVIORS. HOWEVER, A CRITICAL KNOWLEDGE GAP IS THE NEUROBIOLOGY UNDERLYING INTERGENERATIONAL OBESITY IN HUMANS. THE EXTEND TO WHICH MATERNAL OBESITY PROGRAMS CENTRAL REGULATION OF FOOD INTAKE AND RELATED BEHAVIORS IS UNKNOWN. THE FIRST 1,000 DAYS, THE PERIOD FROM CONCEPTION TO AGE TWO, IS CRITICAL FOR THE PREVENTION OF CHILDHOOD OBESITY. THEREFORE, AN UNDERSTANDING OF NEUROBIOLOGICAL AND BEHAVIORAL UNDERPINNINGS DURING THIS WINDOW OF DEVELOPMENTAL PLASTICITY WILL INFORM AN INNOVATIVE APPROACH TO CHILDHOOD OBESITY PREVENTION. THIS PROPOSAL WILL ADDRESS CURRENT KNOWLEDGE GAPS THROUGH TWO COMPLIMENTARY STUDIES: IN STUDY 1, A SECONDARY ANALYSIS OF A DEEPLY-PHENOTYPED PRE-BIRTH COHORT (5R01MH113883), WE WILL (1) DETERMINE THE IMPACT OF PRE-PREGNANCY OBESITY ON NEWBORN REGULATORY BEHAVIORS AND BRAIN CONNECTIVITY IN NETWORKS SUPPORTING REWARD SENSITIVITY AND INHIBITORY CONTROL AND (2) DETERMINE WHETHER VARIATION IN NEWBORN SELF-REGULATION AND BRAIN CONNECTIVITY IS ASSOCIATED WITH BODY MASS INDEX Z-SCORE TRAJECTORIES FROM BIRTH TO TWO YEARS. WE WILL ALSO DESIGN AN INNOVATIVE PILOT STUDY (STUDY 2) TO EVALUATE THE EXTENT TO WHICH NEONATAL BRAIN CONNECTIVITY MEASURES AND MATERNAL OBESITY ARE ASSOCIATED WITH LONGITUDINAL CHANGES IN EATING BEHAVIORS AND SELF-REGULATION FROM BIRTH TO TWO YEARS. IN BOTH STUDIES, ANALYSIS OF GESTATIONAL NEUROTROPHIC ADIPOKINES AND DIETARY INFLAMMATION WILL PROVIDE FURTHER INSIGHT INTO POTENTIAL METABOLIC TARGETS. THIS WILL BE THE FIRST STUDY IN HUMANS TO USE PRENATAL DIETARY ASSESSMENTS, ADVANCED MULTIMODAL IMAGING, INFANT NEUROBEHAVIOR ASSESSMENTS, AND LONGITUDINAL GROWTH MODELLING, WHILE LEVERAGING THE BIOLOGY OF ADIPOCYTES, TO COMPREHENSIVELY CHARACTERIZE A NEUROBIOBEHAVIORAL MODEL OF INTERGENERATIONAL OBESITY. THROUGH A RIGOROUS CAREER DEVELOPMENT PLAN, THE CANDIDATE WILL BUILD ON HER STRONG RESEARCH FOUNDATION AND ACHIEVE FIVE TRAINING GOALS: (1) GAIN IN-DEPTH KNOWLEDGE OF THE NEUROBIOLOGY OF EATING BEHAVIORS AND DEVELOP SKILLS IN NEUROIMAGING ACQUISITION/ANALYSIS; (2) ACQUIRE KNOWLEDGE AND SKILLS IN INFLAMMATORY/ADIPOKINE BIOMARKER ASSESSMENT METHODOLOGIES; (3) BROADEN KNOWLEDGE IN DIETARY ASSESSMENT TOOLS AND ANALYSIS; (4) STRENGTHEN SKILLS IN CAUSAL MEDIATION ANALYSES; (5) MASTER ASSESSMENTS OF EARLY MARKERS OF SELF-REGULATION AND EXECUTIVE FUNCTION. BY THE END OF THE TRAINING PERIOD, THE CANDIDATE WILL POSITION HERSELF UNIQUELY TO ACHIEVE HER GOAL OF BECOMING AN R01-FUNDED INDEPENDENT INVESTIGATOR LEADING AN INNOVATIVE MULTIDISCIPLINARY RESEARCH PROGRAM INVESTIGATING THE NEUROCOGNITIVE BASIS OF INTERGENERATIONAL OBESITY AND POTENTIAL METABOLIC TARGETS DURING PREGNANCY.

PARTNER-SPECIFIC HIV RISK REDUCTION FOR DRUG USING INCARCERATED ADOLESCENTS

THE ROLE OF BIGLYCAN IN REPRODUCTION

CLINICAL TRIAL OF BEHAVIORAL MODIFICATION TO PREVENT CONGENITAL CYTOMEGALOVIRUS

EARLY DETECTION OF AUTISM THROUGH ACOUSTIC ANALYSIS OF CRY

COMPARATIVE EFFECTIVENESS OF INTERVENTIONS FOR LABOR INDUCTION

POSTPARTUM LOW-DOSE ASPIRIN TO AUGMENT VASCULAR RECOVERY FOLLOWING A HYPERTENSIVE DISORDER OF PREGNANCY - PROJECT ABSTRACT CARDIOVASCULAR DISEASE (CVD) IS THE LEADING CAUSE OF DEATH IN WOMEN WORLDWIDE AND DESPITE DECLINES IN ALL OTHER AGE GROUPS, MORTALITY RATES ATTRIBUTED TO CVD ARE INCREASING IN WOMEN OF CHILDBEARING AGE. PREECLAMPSIA IS A WELL-ESTABLISHED RISK FACTOR FOR CVD ACROSS DIVERSE PATIENT POPULATIONS, HOWEVER, THERE ARE CURRENTLY NO EVIDENCE-BASED INTERVENTIONS TARGETING THIS AT-RISK PATIENT POPULATION. WHILE BLOOD PRESSURE CONTROL IS THE CORNERSTONE OF POSTPARTUM MANAGEMENT, EMERGING EVIDENCE SUGGESTS THAT MANAGEMENT OF HYPERTENSION ALONE DOES NOT FULLY MITIGATE CVD RISK AFTER PREECLAMPSIA. THE OVERALL GOAL OF THIS LINE OF RESEARCH IS TO BEGIN TO DEVELOP AND TEST NOVEL PHARMACOLOGIC INTERVENTIONS FOR POSTPARTUM MANAGEMENT FOLLOWING PREECLAMPSIA, REPRESENTING A PARADIGM SHIFT FOCUSED ON ENDOTHELIAL RECOVERY POSTPARTUM IN ADDITION TO BLOOD PRESSURE CONTROL. IN THIS APPLICATION, THE OBJECTIVE IS TO CONDUCT A SINGLE-SITE PILOT TRIAL TO ASSESS THE FEASIBILITY AND EFFECT OF LOW- DOSE ASPIRIN TO AUGMENT VASCULAR RECOVERY IN THE IMMEDIATE POSTPARTUM PERIOD AFTER PREECLAMPSIA THROUGH TWO SPECIFIC AIMS: TO PILOT TEST THE FEASIBILITY OF CONDUCTING A RANDOMIZED CONTROLLED TRIAL OF POSTPARTUM LOW-DOSE ASPIRIN VS. PLACEBO, AND 2) TO ASSESS THE EFFECT OF POSTPARTUM ASPIRIN ON ENDOTHELIAL FUNCTION AND BLOOD PRESSURE. OUR CENTRAL HYPOTHESIS IS THAT POSTPARTUM ADMINISTRATION OF LOW-DOSE ASPIRIN FOLLOWING PREECLAMPSIA WILL BE FEASIBLE, IMPROVE ENDOTHELIAL FUNCTION, AND LOWER BP AT 6 MONTHS POSTPARTUM. THE RESEARCH PROPOSED IN THIS APPLICATION IS INNOVATIVE IN ITS NOVEL ADAPTATION OF AN EVIDENCE-BASED STRATEGY TO IMPROVE VASCULAR FUNCTION AND POSTPARTUM BLOOD PRESSURE IN AN UNDERSTUDIED POPULATION WITH SIGNIFICANT MORBIDITY DURING A CRITICAL TIME PERIOD. THIS PROPOSAL IS SIGNIFICANT AS IT WILL PROVIDE AN OPPORTUNITY TO ASSESS THE FEASIBILITY AND EXPLORE THE EFFECT OF LOW-DOSE ASPIRIN ON VASCULAR FUNCTION IN ADDITION TO BLOOD PRESSURE. EFFECTIVE INTERVENTIONS TO IMPROVE POSTPARTUM HYPERTENSION CARE AND REDUCE LONG-TERM CARDIOVASCULAR RISK HAVE BROAD IMPLICATIONS FOR IMPROVING MATERNAL MORBIDITY AND REDUCING DISPARITIES IN CARE. OUR FINDINGS WILL PROVIDE A VALUABLE FRAMEWORK TO INFORM A SUBSEQUENT LARGE-SCALE RANDOMIZED TRIAL OF LOW-DOSE ASPIRIN IN THE POSTPARTUM PERIOD FOLLOWING PREECLAMPSIA. SUCCESSFUL COMPLETION OF THIS LINE OF RESEARCH WOULD REPRESENT A TRANSFORMATION IN POSTPARTUM MANAGEMENT OF WOMEN WITH HYPERTENSIVE DISORDERS OF PREGNANCY AND HAVE A DIRECT IMPACT TO IMPROVE HYPERTENSION AND CARDIOVASCULAR-RELATED MATERNAL MORBIDITY AND MORTALITY.

ABANDONED INFANTS COMPREHENSIVE SERVICES

RESEARCH ON SCOPE & CAUSES OF STILLBIRTH IN THE US

IMPACT OF A POSTPARTUM LIFESTYLE INTERVENTION ON LACTATION OUTCOMES, BREASTMILK COMPOSITION AND INFANT GROWTH - PROJECT SUMMARY/ABSTRACT OVER 50% OF WOMEN IN THE U.S. ARE OVERWEIGHT OR OBESE WHEN THEY ENTER PREGNANCY. WOMEN WITH OBESITY ARE 2.6 TIMES MORE LIKELY TO EXPERIENCE LACTATION FAILURE, INDEPENDENT OF INTENTION TO BREASTFEED, CONTRIBUTING TO ADVERSE HEALTH OUTCOMES FOR TWO GENERATIONS. INFLAMMATION, A METABOLIC HALLMARK OF OBESITY, HAS BEEN ASSOCIATED WITH LACTATION FAILURE, BUT MECHANISTIC STUDIES EVALUATING THE MECHANISMS UNDERLYING LACTATION FAILURE IN WOMEN ARE SPARSE. WE NOW HAVE A UNIQUE OPPORTUNITY TO ADDRESS THIS KNOWLEDGE GAP THROUGH THE LIFESTYLE INTERVENTION IN PREPARATION FOR PREGNANCY (LIPP) STUDY, A RANDOMIZED CONTROLLED TRIAL OF A LIFESTYLE (NUTRITIONAL AND EXERCISE) INTERVENTION IN WOMEN WITH OVERWEIGHT AND CLASS I OBESITY WHO ARE PLANNING A SUBSEQUENT PREGNANCY IN THE NEXT TWO YEARS. LIPP PARTICIPANTS ARE RECRUITED THREE MONTHS POST-PARTUM AND AFTER BASELINE METABOLIC MEASUREMENTS, ARE RANDOMIZED TO A CLOSELY SUPERVISED LIFESTYLE INTERVENTION, CONSISTING OF CALORIC RESTRICTION WITH A SHIFT TO A MEDITERRANEAN DIET PATTERN AND EXERCISE FOR 9-21 MONTHS, OR STANDARD CARE. THE LIPP LACTATION STUDY SEEKS TO UNDERSTAND THE IMPACT OF THIS INTERVENTION ON LACTATION OUTCOMES AND BREASTMILK COMPOSITION. OUR OVERALL HYPOTHESIS IS THAT A FAVORABLE POST-PARTUM METABOLIC ENVIRONMENT HAS A DURABLE IMPACT ON THE METABOLIC HEALTH OF TWO GENERATIONS THROUGH LONGER LACTATION DURATION AND ALTERED BREASTMILK FATTY ACID COMPOSITION. WE WILL EVALUATE THIS HYPOTHESIS THROUGH THE FOLLOWING SPECIFIC AIMS: AIM 1. TO QUANTIFY THE EFFECT OF A POST-PARTUM LIFESTYLE INTERVENTION ON LACTATION DURATION AND IDENTIFY UNDERLYING MECHANISMS; AIM 2. TO DETERMINE THE IMPACT OF A LIFESTYLE INTERVENTION AND SUBSEQUENT DIETARY AND ENERGY EXPENDITURE PATTERNS ON BREASTMILK FATTY ACID COMPOSITION AND INFANT GROWTH; EXPLORATORY AIM 3. TO IDENTIFY THE IMPACT OF MATERNAL LIFESTYLE INTERVENTION ON BREASTMILK METABOLOMIC PATTERNS. THE POST-PARTUM PERIOD HAS BEEN UNDER-LEVERAGED AS A CRITICAL PERIOD TO IMPROVE LIFELONG MATERNAL AND INFANT HEALTH. SCIENTIFICALLY, THE LIPP LACTATION STUDY WILL FUNDAMENTALLY AND RIGOROUSLY INFORM OUR UNDERSTANDING OF THE MECHANISMS UNDERLYING LACTATION OUTCOMES AND THE MATERNAL PREDICTORS OF BREASTMILK COMPOSITION BY LEVERAGING THE RCT DESIGN OF THE PARENT LIPP STUDY. FROM A PUBLIC HEALTH STANDPOINT, LIPP LACTATION PROVIDES A UNIQUE OPPORTUNITY TO IDENTIFY DISCRETE METABOLIC TARGETS FOR INTERVENTION IN WOMEN WITH OBESITY, TO IMPROVE THE LIFELONG HEALTH OF TWO GENERATIONS.

INTER-ALPHA INHIBITORS: NOVEL NEUROINFLAMMATORY MODULATOR OF NEONATAL BRAIN INJURY

BENEFICIAL EFFECTS OF INTER-ALPHA INHIBITORS IN FETAL BRAIN INJURY

CYTOSKELETAL REGULATION OF ENDOTHELIAL BARRIER FUNCTION BY WAVE2

TAILORED OUTCOMES FOR FEMALE URINARY INCONTINENCE

POSTPARTUM SLEEP EFFECTS ON SMOKING RELAPSE

COMPUTER-BASED INTERVENTION FOR VICTIMIZED PERINATAL WOMEN WITH MENTAL ILLNESS

MATERNAL OPIOID TREATMENT: HUMAN EXPERIMENTAL RESEARCH

NURISHING BEGINNINGS: THE ROLE OF PRENATAL NUTRITION IN OFFSETTING STRESS-RELATED DEVELOPMENTAL RISKS - MATERNAL PRENATAL STRESS AND NUTRITION INFLUENCE FETAL GROWTH AND LONG-TERM CHILD OUTCOMES. MATERNAL PERCEIVED STRESS AND UNDERNUTRITION FREQUENTLY CO-OCCUR AND AFFECT OVERLAPPING BIOLOGICAL STRESS PATHWAYS RELATED TO OXIDATIVE STRESS, STILL, LITTLE IS KNOWN ABOUT THE INTERACTIVE EFFECTS OF MATERNAL PRENATAL STRESS AND NUTRITION ON FETAL AND LONG-TERM CHILD OUTCOMES AND NEUROLOGICAL DEVELOPMENT. THE PROPOSED R00 RESEARCH WILL LEVERAGE DATA FROM THE “ENHANCING NUTRITION AND ANTENATAL INFECTION TREATMENT FOR MATERNAL AND CHILD HEALTH” (ENAT) TRIAL TO EXAMINE INTERACTIVE EFFECTS OF MATERNAL PRENATAL STRESS AND NUTRITION INTERVENTION ON LONG-TERM CHILD OUTCOMES. THE ENAT STUDY RANDOMIZED N=2390 PREGNANT WOMEN TO RECEIVE AN “ENHANCED NUTRITION” PACKAGE OR “STANDARD CARE” AND COLLECTED DATA ON MATERNAL PRENATAL STRESS (COHEN’S PERCEIVED STRESS SCALE) THROUGHOUT THE PRE- AND POSTNATAL PERIOD. USING DATA FROM ENAT, WE WILL DETERMINE INDEPENDENT AND INTERACTIVE EFFECTS OF MATERNAL PRENATAL PERCEIVED STRESS AND NUTRITION INTERVENTION ON CHILDREN’S COGNITIVE AND NEURAL DEVELOPMENTAL AT 24 MONTHS OF AGE. CHILD OUTCOMES WILL INCLUDE STRESS-SENSITIVE OUTCOMES PREVIOUSLY SHOWN TO BE SENSITIVE TO EARLY LIFE ADVERSITY, INCLUDING ATTENTION, MEMORY, AND LANGUAGE. WE WILL ALSO USE ELECTROENCEPHALOGRAPHY (EEG) TO EXAMINE NEURAL OSCILLATION ACROSS DIFFERENT FREQUENCY BANDS AS AN INDEX OF NEURAL MATURATION. TO STUDY UNDERLYING BIOLOGICAL PATHWAYS, WE WILL USE MATERNAL AND INFANT BLOOD SAMPLES EXAMINE WHETHER MATERNAL AND NEWBORN TELOMERE LENGTHS MAY SERVE AS BIOMARKERS OF IN-UTERO PROGRAMMING OF BIRTH AND CHILD OUTCOMES IN RELATION TO MATERNAL PRENATAL PERCEIVED STRESS AND NUTRITION. WE HYPOTHESIZE THAT HIGHER LEVELS OF MATERNAL PRENATAL STRESS WILL BE ASSOCIATED WITH POORER COGNITIVE AND NEURAL OSCILLATORY CHILD OUTCOMES. TELOMERES ARE NON-CODING TANDEM REPEATS AT THE END OF THE CHROMOSOMES THAT MAINTAIN GENOME AND CELL INTEGRITY. TELOMERES ERODE OVER TIME AND STRESS AND POOR NUTRITION CAN LEAD TO ACCELERATED EROSION AND CELLULAR AGING. CHILDREN WITH LOW BIRTHWEIGHT HAVE BEEN FOUND TO HAVE SHORTER TELOMERES. WE THEREFORE HYPOTHESIZE THAT EFFECTS OF PRENATAL STRESS ON BIRTH AND CHILD OUTCOMES WILL BE MEDIATED BY MATERNAL AND NEWBORN TELOMERE LENGTH, BUT THAT SUCH ASSOCIATIONS WILL BE ATTENUATED IN OFFSPRING OF WOMEN WHO RECEIVED NUTRITION INTERVENTION THIS R00 WILL ENABLE ME TO LEAD AN INNOVATIVE RESEARCH PROGRAM IN CHILD NEURODEVELOPMENT AND ESTABLISH ME AS A LEADER AND INNOVATIVE SCHOLAR UTILIZING ADVANCED METHODS TO UNCOVER MECHANISTIC PROCESSES THAT SHAPE CHILDHOOD DEVELOPMENT IN DOMESTIC AND GLOBAL SETTINGS. THE PROPOSED RESEARCH ALIGNS WITH NICHD’S GOAL TO SET A FOUNDATION FOR HEALTHY PREGNANCIES AND LIFELONG LIVING. WE WILL GENERATE EPIDEMIOLOGIC AND BIOLOGIC EVIDENCE LINKING MATERNAL PRENATAL NUTRITION AND STRESS WITH NEWBORN AND CHILDHOOD OUTCOMES THAT ARE SENSITIVE TO PRENATAL STRESS AND FORM LONG-TERM OUTCOMES RELATED TO SCHOOL ACHIEVEMENT AND MENTAL HEALTH. WE WILL USE THIS KNOWLEDGE TO GUIDE PUBLIC HEALTH DECISIONS REGARDING PRE- AND POSTNATAL INTERVENTION BOTH DOMESTICALLY AND GLOBALLY, AND TO DEVELOP FUTURE INTERVENTION TO SUPPORT OPTIMAL CHILD DEVELOPMENT AND HEALTH.

HIGH-RISK NEUROBLASTOMA: A DEVASTATING CHILDHOOD CANCER

CAREGIVING INFLUENCES ON ATTENTION AND EXECUTIVE FUNCTION IN CHILDREN BORN VERY PRETERM - PROJECT SUMMARY / ABSTRACT CHILDREN BORN VERY PRETERM ARE AT INCREASED RISK FOR DEFICITS IN ATTENTION AND EXECUTIVE FUNCTION, TWO DOMAINS THAT ARE STRONGLY IMPLICATED IN LONG-TERM HEALTH AND DEVELOPMENTAL OUTCOMES. WE HAVE NOT YET IDENTIFIED MODIFIABLE ENVIRONMENTAL FACTORS THAT COULD PREVENT OR MITIGATE COGNITIVE DEFICITS IN VERY PRETERM CHILDREN AT SCHOOL AGE, THOUGH RESEARCH WITH YOUNGER CHILDREN SUGGESTS THAT CAREGIVING QUALITY IS A POTENT PROTECTIVE FACTOR. UNDERSTANDING RELATIONSHIPS BETWEEN DIMENSIONS OF CAREGIVING QUALITY AND CHILD ATTENTION AND EXECUTIVE FUNCTION AT SCHOOL-AGE IS CRITICALLY IMPORTANT AS THE TRANSITION TO FORMAL SCHOOLING POSES NEW CHALLENGES FOR CHILDREN AND FAMILIES. YET, EXISTING INTERVENTIONS TARGETING CAREGIVING QUALITY IN PRETERM DYADS HAVE EXCLUSIVELY FOCUSED ON EARLY INFANCY AND NOT SURPRISINGLY, THE POSITIVE EFFECTS OF THESE INTERVENTIONS ARE COMPLETELY WASHED OUT BY SCHOOL AGE. A WIDER FOCUS ON CAREGIVING AS A PROTECTIVE FACTOR FOR PRETERM CHILDREN DURING THE SENSITIVE PERIOD REPRESENTED BY THE TRANSITION TO FORMAL SCHOOLING IS CRITICAL. WITH FUNDS FROM OUR PRIOR AWARDS (R01HD072267; R01HD084515), WE ESTABLISHED A COHORT OF VERY PRETERM INFANTS RECRUITED AT BIRTH (NOVI STUDY) AND HAVE DEMONSTRATED PROSPECTIVE ASSOCIATIONS AMONG EARLY CAREGIVING FACTORS (E.G., PSYCHOLOGICAL DISTRESS) AND CHILD NEURODEVELOPMENTAL OUTCOMES AT AGE 2. THE NOVI COHORT WAS SELECTED FOR INCLUSION IN THE NIH ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES (ECHO) PROGRAM (UG3OD23347; UH3OD23347) WHICH PROVIDED FUNDING FOR EXTENSIVE PHENOTYPIC CHARACTERIZATION OF NOVI CHILDREN THROUGH AGE 7, INCLUDING ASSESSMENTS OF CHILD ATTENTION AND EXECUTIVE FUNCTION. WE ADDITIONALLY COLLECTED AN OBSERVATIONAL MEASURE OF CAREGIVING QUALITY AT THE AGE 7 VISIT WHICH WAS NOT PART OF THE ECHO PROTOCOL AND REQUIRES ADDITIONAL RESOURCES FOR CODING AND ANALYSIS. THE CURRENT PROPOSAL AIMS TO CODE MULTIPLE DIMENSIONS OF CAREGIVING QUALITY (E.G., CAREGIVER SENSITIVITY AND STRUCTURING) FROM THE OBSERVATIONAL CAREGIVER-CHILD INTERACTION TASK. THESE NEW DATA WILL PROVIDE VITAL INFORMATION THAT COULD EXPLAIN THE TREMENDOUS VARIABILITY IN CHILD ATTENTION AND EXECUTIVE FUNCTION WE OBSERVE IN THE NOVI COHORT. USING BOTH NEW AND EXISTING DATA, THIS PROPOSAL AIMS TO DETERMINE (A) CHILD-, CAREGIVER-, AND FAMILY- RELATED PREDICTORS OF CAREGIVING QUALITY AND (B) ASSOCIATIONS BETWEEN CAREGIVING QUALITY AND CHILD ATTENTION AND EXECUTIVE FUNCTION DURING THE SCHOOL-AGE PERIOD IN CHILDREN BORN VERY PRETERM. FINDINGS FROM THIS STUDY WILL ADVANCE THEORY REGARDING THE CONTRIBUTIONS OF CAREGIVING QUALITY TO THE DEVELOPMENT OF VERY PRETERM CHILDREN AND COULD BE USED TO CREATE INTERVENTIONS TO MITIGATE COGNITIVE DEFICITS IN VERY PRETERM CHILDREN DURING THE TRANSITION TO SCHOOL. BY PINPOINTING PREDICTORS OF CAREGIVING QUALITY, THESE RESULTS COULD ALSO BE USED TO IDENTIFY PRETERM CHILDREN AND THEIR CAREGIVERS WHO COULD BENEFIT MOST FROM A NOVEL CAREGIVING INTERVENTION.

2D-4D CAPABLE ULTRASOUND MACHINE

PRE- AND POSTNATAL NEUROBEHAVIORAL PROFILES IN INFANTS AT RISK FOR AUTISM

EFFECTS OF FORCE AND HORMONAL ENVIRONMENT ON CERVICAL MATRIX

SLEEP AND BIOLOGICAL RHYTHMS AFTER FETAL EXPOSURE TO ANTIDEPRESSANTS

THE IMPACT OF PRENATAL COCAINE EXPOSURE, ENVIRONMENTAL RISK, AND TRAJECTORIES

IMPROVING HEALTH AND SCIENCE LITERACY IN A LATINO COMMUNITY

ANTIBODY IN DEFENSE AGAINST NEONATAL CANDIDA INFECTIONS

NONLINGUISTIC VOCALIZATIONS IN AUTISM: ACOUSTIC CRY ANALYSIS IN EARLY INFANCY