# Social and biological determinants of pregnancy-related mortality and morbidity among rural, underserved women

> **NIH NIH F30** · UNIVERSITY OF KENTUCKY · 2021 · $51,036

## Abstract

ABSTRACT
 Over the past two decades, the number of women dying from pregnancy-related causes in the United
States has nearly doubled, and cases of severe maternal morbidity have nearly tripled.2, 3 Research
concerning the factors influencing pregnancy-related mortality (PRM) and severe maternal morbidity (SMM)
has previously neglected women in Central Appalachia, despite the risk profile of this health disparate
population. This study utilizes a rigorous mixed methods approach guided by the conceptual framework for
action on the social determinants of health adopted by the World Health Organization to identify structural and
intermediary determinants influencing Central Appalachian women's risk for SMM and PRM.1, 4
 This study is highly innovative in that it is the first study nationally outside the National Center for Health
Statistics (NCHS) to utilize a new database from the NCHS, which links morbidity and mortality data.
Furthermore, it is the first known study to focus on SMM and PRM in women living in Central Appalachia, and
may yield critical intervention insights for this underserved, health disparate population.
 The following aims will:
(1) Identify predictors of PRM and SMM in Central Appalachia. This aim will perform hierarchical logistic
regressions on nation-wide data from the NCHS to determine risk and protective factors influencing women's
risk of SMM and PRM at delivery and one year postpartum.
(2) Elucidate healthcare providers' and patients' perspectives on underlying mechanisms of PRM and SMM in
Central Appalachia. In-depth semi-structured interviews will be conducted with: (1) 10 patients who have
experienced SMM, and (2) 10 healthcare providers and 10 EMTs in Central Appalachia who have provided
care for patients experiencing SMM and PRM.
 The PI will leverage resources and expertise from the University of Kentucky's Center for Health Equity
Research, Research Data Center, and a highly supportive interdisciplinary mentorship team who are experts
in rural health disparities, implementation science, and maternal-fetal medicine. Mentorship by team members
will provide the PI with ample training concerning the implementation of mixed methods studies, project
management, responsible conduct of research, and the dissemination of findings. This training will provide the
PI with the skillset necessary to carry out the specific aims, and lay the foundation for the PI to become an
independent physician-scientist with an extramurally supported research portfolio in the field of maternal
health. Results from this study will produce essential knowledge concerning predictors of SMM and PRM in an
at-risk population, and identify factors influencing poor maternal outcomes which may be targeted by future
interventions. Findings may also inform development of future empirical investigations into in other rural
populations.

## Key facts

- **NIH application ID:** 10236293
- **Project number:** 5F30HD103319-02
- **Recipient organization:** UNIVERSITY OF KENTUCKY
- **Principal Investigator:** Anna Hansen
- **Activity code:** F30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $51,036
- **Award type:** 5
- **Project period:** 2020-08-02 → 2024-08-01

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10236293

## Citation

> US National Institutes of Health, RePORTER application 10236293, Social and biological determinants of pregnancy-related mortality and morbidity among rural, underserved women (5F30HD103319-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10236293. Licensed CC0.

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