Preconception contributors to severe maternal morbidity in black and white women

怀孕前导致黑人和白人妇女严重孕产妇发病的因素

• 批准号: 10200386
• 负责人: Janet M Catov
• 金额: $ 23.12万
• 依托单位: MAGEE-WOMEN'S RES INST AND FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200386
• 关键词: Address; Affect; Age; Atherosclerosis; Birth; Blood Circulation; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Coronary Artery Risk Development in Young Adults Study; Data; Discrimination; Enrollment; Epidemic; Event; Functional disorder; Funding; Gestational Diabetes; Goals; Health Services Accessibility; Hospitalization; Inflammatory; Intervention; Life; Life Style; Link; Lipids; Maternal Health; Maternal Mortality; Metabolic Diseases; Modality; Morbidity - disease rate; Mothers; National Heart, Lung, and Blood Institute; Nature; Obesity; Outcome; Parents; Pattern; Persons; Play; Pregnancy; Pregnancy Complications; Premature Birth; Prevention strategy; Race; Research; Risk; Role; Social support; Stress; Structure; Surveys; Time; Woman; Women' s Health; adverse pregnancy outcome; biobehavior; cardiometabolism; cardiovascular health; cardiovascular risk factor; child bearing; cohort; design; evidence base; follow-up; high risk; improved; insight; novel; pregnancy disorder; premature; prepregnancy; prospective; racial difference; racial disparity; reproductive; severe maternal morbidity; social health determinants; social stressor; trend; young adult

ABSTRACT Adverse pregnancy outcomes (APO), including hypertensive disorders of pregnancy, preterm birth, and gestational diabetes, are associated with short- and long-term cardiovascular risk in mothers. The urgency of these associations is amplified by an `unexplained epidemic' of increased CVD risk among young adult women (age 35 to 55) (ref; Vaccarino, Circulation 2019). These CVD trends coincide with unexplained increases in severe maternal morbidity (SMM) and mortality in the U.S, the dominant cause being cardiovascular in nature. (Creanga 2017) Further complicating these trends of deteriorating cardiovascular health in young adult women are profound and persistent race disparities, with black women having rates of CVD and severe maternal morbidity 2 to 3 times higher than white women (Peterson 2019). Social determinants of health including stress, discrimination and access to care are also known contributors to CVD risk and SMM, but to date these have not been studied in a comprehensive and synergistic fashion to understand precursors and contributors to racial disparities in SMM. Our on-going NHLBI-funded study, Shared antecedents to preterm birth and CVD in women (R21HL145419), is uniquely poised to disentangle these questions. It also provides a unique opportunity to expand research on the leading causes of maternal mortality and severe maternal morbidity in order to strengthen evidence-based care and prevention strategies and improve maternal health. The CARDIA study has conducted up to 9 in-person exams among 2,787 women (50% Black), of whom 1,362 delivered 2,389 births from baseline and up to the year 30 follow-up exam (1985-2015). There are extensive longitudinal data on blood pressure, lipids, glycemia, cardiac structure, adiposity, lifestyle, metabolic diseases, and subclinical atherosclerosis. Uniquely, these exams include longitudinal data on stress, social determinants of health and discrimination. We propose to assemble these features to study 900 CARDIA women from both before and after pregnancies. We hypothesize that cardiometabolic, inflammatory and social stressors prior to pregnancy converge and contribute to racial disparities in severe maternal morbidity and premature CVD. Assessing pre-conception bio-behavioral markers will provide novel insights into the pathophysiology of pregnancy-associated morbidity as well as identify modalities to mitigate CVD in women of reproductive age.

抽象的 不良怀孕结果（APO），包括怀孕的高血压疾病，早产 出生和妊娠糖尿病与短期和长期心血管风险有关 母亲。这些关联的紧迫性被“无法解释的流行病”扩大 年轻妇女的CVD风险增加（35至55岁）（参考； Vaccarino，《流通2019》）。 这些CVD趋势与严重的母体发病率（SMM）和无法解释的增加相吻合 在美国，死亡率是心血管的主要原因。 （Creanga 2017）进一步 使这些年轻女性恶化的心血管健康恶化的趋势变得复杂 黑人妇女的CVD和严重程度很高 孕产妇发病率是白人妇女的2至3倍（Peterson 2019）。社会决定因素 健康，包括压力，歧视和获得护理的机会也是CVD的已知贡献者 风险和SMM，但迄今为止，这些尚未在全面而协同的中研究 了解SMM种族差异的前体和贡献者的时尚。我们正在进行的 NHLBI资助的研究，与女性的早产和CVD共享（R21HL145419）， 被唯一准备解决这些问题。它还提供了一个独特的机会 扩大对孕产妇死亡的主要原因和严重孕产妇发病率的研究 为了加强基于证据的护理和预防策略并改善产妇 健康。 Cardia研究在2,787名妇女中最多进行了9次面对面考试（50％ 黑色），其中1,362人从基线和30年的随访中分娩了2,389个出生 考试（1985-2015）。关于血压，脂质，血糖，有广泛的纵向数据， 心脏结构，肥胖，生活方式，代谢疾病和亚临床动脉粥样硬化。 这些考试独特地包括有关压力的纵向数据，健康的社会决定因素和 歧视。我们建议组装这些功能，以研究两者的900个Cardia女性 怀孕前后。我们假设这种心脏代谢，炎症和 怀孕之前的社会压力源会融合并导致种族差异 严重的母体发病率和过早的CVD。评估概念前的生物行为 标记将提供有关妊娠相关发病率的病理生理学的新见解 以及确定生殖年龄妇女中CVD的方式。