Location: Healthy Body Weight Research
Project Number: 3062-51000-054-005-R
Project Type: Reimbursable Cooperative Agreement
Start Date: Mar 1, 2022
End Date: Feb 28, 2024
Objective:
Cardiovascular disease (CVD) is the leading cause of mortality among American Indian populations, and cardiovascular-related premature mortality among this population is worsening. Between 2000 and 2015, CVD mortality rates among American Indian individuals aged 25-49 years increased by up to 2.1%, yet declined or plateaued among similarly aged individuals in other racial/ethnic groups in the U.S. The American Heart Association has called for studies of the consequences of childhood adversity on CVD among American Indian populations, including intergenerational effects of childhood adversity. Adverse Childhood Experiences (ACEs), traumatic events that occur during the first 18 years of life, such as violence, abuse, or exposure to substance abuse, are prevalent among American Indian populations. Northern Plains American Indian populations may be especially at risk for exposure to =2 ACEs. Of note, 51% of pregnant American Indian women in North Dakota have been exposed to =2 ACEs compared to 35% of pregnant White women in North Dakota.
Excessive infant growth has been linked with increased risk of later CVD. Evidence among American Indian populations suggests growth during the first year of life is associated with poor cardiovascular health among children age 5 to 8 years, which in turn may increase risk for CVD in adulthood. A dose-response relationship has been reported between exposure to ACEs and cardiovascular-related morbidity and mortality in the U.S. However, to the best of our knowledge, there is no evidence regarding the intergenerational cardiovascular consequences of exposure to ACEs. The proposed study will establish a unique cohort of pregnant American Indian women and their infants to address the recent call for investigation of cardiovascular risk factors among American Indian populations, including the examination of potential pathways.
Stress and Health in American Indian Pregnancies (SHAIP) will be a prospective cohort study of ACEs and maternal and infant outcomes. Approximately 375 pregnant American Indian women in North Dakota will be enrolled at or prior to 36 weeks gestation, with maternal hair sample and survey data collected once during pregnancy and at 6 months postpartum and 12 months postpartum. Infant hair sample will be collected at 6 months postpartum 12 months postpartum. Medical records for the mothers and infants will be collected during pregnancy, at delivery, at 6 months postpartum and at 12 months postpartum. In order to better understand the associations between maternal ACEs and infant growth, the following specific aims will be achieved:
Aim 1. Test the hypothesis that high levels of maternal ACEs are associated with increased maternal cortisol levels during pregnancy.
Aim 2. Test the hypothesis that high levels of maternal ACEs are associated with increased risk for poor maternal and obstetric outcomes, as mediated by prenatal cortisol levels.
Aim 3. Test the hypothesis that high levels of maternal ACEs are associated with increased rate of infant growth at 6 months and 12 months, as mediated by obstetric outcomes, prenatal cortisol levels, and infant feeding.
Approach:
In cooperation with the COBRE team and tribal communities in ND, we propose to recruit 375 pregnant AI women who are at least 18 years of age and =36 weeks gestation seeking prenatal care at Fort Yates Hospital (Fort Yates, ND), Burdick Memorial Health Care Facility (Belcourt, ND), or Elbowoods Memorial Health Center (New Town, ND). We will collect data at 4 points during the study: Pyschosocial, socioedemographic, and health behavior data and hair samples (see Measures) will be collected from the mother at time of enrollment (T1), at 6 months postpartum (T3) and at 12 months postpartum (T4). Infant hair samples will be collected at 6 months postpartum (T3) and at 12 months postpartum (T4). Medical record data will be collected for mothers and infants throughout the study. All study visits will coincide with previously scheduled clinic visits to reduce time and travel commitments for participants. Recruitment will begin in January 2021.
Measures. The below measures will be collected as part of the SHAIP study. Tribal IRB officials contributed to the inclusion of the below measures:
Adverse Childhood Experiences: 10 types of childhood trauma, covering, covering the first 18 years of life.
Historical Losses Scale: 12 measure survey designed to measure frequency with which AI individuals think about historical loss.
Connor-Davidson Resilience Scale (CD-RISC 2): 2 question instrument designed as a quick screen of an individual’s resilience, or the ability to bounce back and successfully adapt to change.
Patient Health Questionnaire-2 (PHQ-2): 2 measure survey designed to assess frequency of depressed mood over the previous 2 weeks.
Generalized Anxiety Disorder 2-item (GAD-2): 2 measure survey designed to screen for generalized anxiety disorder, regarding the previous 2 weeks.
Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Self-reported, 5 measure survey designed to identify persons with probable PTSD, regarding symptoms over the past month.
Alcohol Use Disorders Identification Test (AUDIT-C): Self-reported, 3 measure survey regarding alcohol use.
Perceived Stress Scale: 10 items. Widely used psychological instrument for measuring perception of stress over the previous month.
Wicozani Instrument: Measure of 9 items. Newly developed measure of AI health and well-being that addresses Western frameworks.
Hair Cortisol: Hair cortisol concentration is considered a valid measure of chronic stress and stress during pregnancy, and has been used among infants. SHAIP personnel will be trained in methods to collect and store hair samples of approximately 3mm in diameter and at least 3cm in length, as close to the scalp as possible from the posterior vertex position. Hair samples will allow for cortisol concentration over the previous 3 months as 1 cm in length can be used to assess cortisol during the previous 1 month. Samples will be analyzed following methods described by Kirshbaum et al.
Infant growth: Age and gender-specific z-scores will be calculated for each anthropometric measurement (length, weight, head circumference) at birth and at 6 months and 12 months postpartum, standardized on U.S. Centers for Disease Control and Prevention growth chart
