Grant Abstract: Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbidity

Grant Number: 1U54HD113142-01
PI Name: El-Sayed
Project Title: Stanford PRIHSM: PReventing Inequities in Hemorrhage-related Severe Maternal Morbidity

Abstract: Overall Postpartum hemorrhage (PPH) is a leading cause of maternal death and severe maternal morbidity (SMM) and disproportionately affects socially marginalized groups. We propose to create a Maternal Health Research Center of Excellence at Stanford University called PRIHSM (PReventing Inequities in Hemorrhage-related Severe Maternal morbidity). The goals of PRIHSM are to reduce PPH and associated SMM by reducing antenatal iron deficiency anemia (IDA), addressing disparities in rates of cesarean birth and cesarean-linked PPH, and attending to the impact of PPH on postpartum mental health. IDA affects approximately 16% of pregnancies in the U.S.; rates are 3-4x higher among Black people and 1.5-2x higher among Latinx people, compared to the rest of the population. This translates to higher rates of PPH-related SMM. We propose that by effectively addressing antenatal IDA and these disparities, we can reduce PPH-related SMM. Intrapartum exposures also play a major role in the risks and disparities associated with PPH. Almost 1 in 3 U.S. births are by cesarean delivery, rates vary 10-fold across hospitals, and Black and Asian individuals have the highest prevalence of cesarean section among low-risk pregnancies. We propose that enhanced birth equity and reduced variability in obstetric management are important strategies in addressing disparities in cesarean- linked PPH and reducing PPH-related SMM. PPH may also dramatically alter the postpartum emotional life course. Prospective longitudinal research to understand mental health trajectories following PPH is needed, as are effective treatments. We propose an approach that is innovative in that it targets the unique clinical and mental health spectrum of PPH at multiple intervention points, through multi-disciplinary, community-engaged science. Our Aims are: Aim 1 (Project 1). Reduce antenatal IDA by developing, implementing, and disseminating a patient-informed Anemia Prevention Toolkit, which will standardize the evaluation, diagnosis, and treatment of IDA and reduce the prevalence of IDA and racial/ethnic disparities in IDA at birth admission and PPH-associated SMM. Aim 2 (Project 2). Reduce disparities in rates of primary cesarean birth and cesarean-linked PPH by conducting a mixed methods study to understand drivers of hospital-level disparities in these outcomes, and implementing a patient-informed Maternal Equity Guide. Aim 3 (Project 3). Advance our understanding of PTSS following severe PPH by examining the course of PTSS following PPH, and implementing patient-informed PTSD treatment and prevention strategies. Our work will involve community- university partnerships focused on improving maternal health equity and be driven by perspectives of patients, providers, and healthcare leadership. Our work will provide training opportunities to build research and clinical expertise relevant to PPH, especially among individuals who represent diverse perspectives and experiences within academic and community-based settings, and under-served areas. We propose a bold yet achievable agenda that will affect a sustainable decline in PPH-related mortality and morbidity and disparities. PUBLIC HEALTH RELEVANCE: : Overall Postpartum hemorrhage (PPH) is a leading cause of maternal death and severe maternal morbidity (SMM) and disproportionately affects socially marginalized groups. The goals of this center are to reduce PPH and associated SMM by (1) reducing antenatal iron deficiency anemia, (2) addressing disparities in rates of cesarean birth and cesarean-linked PPH, and (3) attending to the impact of PPH on postpartum mental health. We propose a research agenda that includes scalable interventions that will lead to sustainable declines in all of these outcomes and realization of maternal health equity.

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