Preconception and prenatal stress effects on cardiovascular disease risk in black women

受孕前和产前应激对黑人女性心血管疾病风险的影响

• 批准号: 10458038
• 负责人: ALISON E HIPWELL
• 金额: $ 67.93万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10458038
• 关键词: Acute; Address; Adult; Affect; Behavioral; Biological; Birth; Black American; Black race; Blood; Blood Glucose; Blood Pressure; Buffers; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Childhood; Chronic stress; Data; Development; Diet; Discipline of obstetrics; Discrimination; Disease; Early identification; Exposure to; Fetal Development; Future; Health; Healthcare; Heterogeneity; Hydrocortisone; Individual Differences; Intervention; Knowledge; Laboratories; Life Stress; Link; Lipids; Longevity; Longitudinal Studies; Low income; Maternal Health; Maternal Mortality; Measures; Mediating; Modeling; Morbidity - disease rate; Obesity; Outcome; Pathway interactions; Perinatal; Persons; Phenotype; Physiological; Polyunsaturated Fatty Acids; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimesters; Pregnant Women; Prenatal care; Prevention; Prevention Guidelines; Primary Prevention; Prospective Studies; Regulation; Reproductive Health; Research; Risk; Role; Salivary; Sampling; Second Pregnancy Trimester; Smoking; Stress; Stress Tests; System; Testing; Third Pregnancy Trimester; Time; Violence; Woman; Women' s Health; Work; acute stress; adverse birth outcomes; behavior change; biobehavior; biopsychosocial; black women; cardiometabolism; cardiovascular disorder risk; cardiovascular risk factor; causal model; dietary; early experience; girls; heart rate variability; improved; inflammatory marker; innovation; maternal morbidity; minority stress; mortality; multidisciplinary; novel; postpartum health; prenatal; prenatal stress; preventive intervention; protective effect; racial disparity; racial health disparity; recruit; response; stress reactivity; stressor

PROJECT SUMMARY Cardiovascular disease (CVD) is a leading cause of mortality and morbidity and disproportionately affects Black American women. Compelling evidence highlights pregnancy as an important window for identifying future CVD risk. Although Black women are also at elevated risk for cardiovascular complications during pregnancy, heterogeneity is poorly understood and differentiated phenotypes of CVD risk before, during and after pregnancy are lacking. Consistent with models of racial stress, Black women are often exposed to contextual stressors (e.g., discrimination stress, adversity, violence) over the lifespan that contribute to racial disparities in health via alterations in stress regulation systems. Prenatal stress reactivity has been linked to poor obstetric health and adverse birth outcomes, but the effects of on women’s cardiovascular morbidity in the postpartum period are unclear. In response to RFA-MD-20-800 ‘Addressing Racial Disparities in Maternal Mortality and Morbidity’, the proposed research examines individual differences in prenatal stress regulation as a biological pathway through which early and chronic stress exposure impacts postpartum CVD risk among Black women. The study also builds on growing evidence shows that dietary polyunsaturated fatty acids (PUFAs) are associated with reduced stress reactivity and CVD risk, and our own work with Black women supports their utility as a modifiable target for intervention during pregnancy. Thus, we will explore the protective effects of prenatal PUFA levels on the association between lifetime stress and postpartum CVD risk. The Pittsburgh Girls Study (PGS), a 20-year longitudinal study that began annual assessments of stress exposures in childhood, provides an unprecedented opportunity to elucidate phenotypes of peripartum CVD risk as a function of lifetime stress. We propose to recruit Black pregnant women (N = 400) from the PGS and collect biobehavioral measures of CVD risk (i.e., lipids, blood sugar, blood pressure, adiposity, diet, smoking and activity) and inflammatory markers at 2, 12 and 24 months postpartum. These new data will be linked to extant PGS data on preconception and prenatal CVD biobehavioral markers, lifetime stress exposures, and prenatal stress regulation to address the following Specific Aims among Black women: (1) Elucidate peripartum phenotypes of CVD risk related to life stress; (2) Examine the impact of prenatal stress regulation on postpartum CVD risk; and (3) Explore the moderating effects of prenatal PUFAs on CVD risk. The proposed longitudinal study builds on the prior work of the multidisciplinary investigative team and will provide the first rigorous examination of peripartum phenotypes of CVD risk among Black women. Achieving the stated aims will inform causal models of risk and generate critical knowledge for optimizing the timing of, and novel targets for, interventions to reduce persistent racial disparities in maternal cardiovascular morbidity.

项目摘要 心血管疾病（CVD）是死亡率和发病率的主要原因，并且不成比例地影响 黑人妇女。令人信服的证据突出了怀孕，作为识别的重要窗口 未来的CVD风险。尽管黑人妇女在心血管并发症中的风险也较高 怀孕，异质性知之甚少，并且在和 怀孕后缺乏。与种族压力的模型一致，黑人妇女经常暴露于 在造就种族的寿命中，上下文压力源（例如，歧视压力，广告，暴力） 通过改变压力调节系统的健康差异。产前应力反应性已与 产科健康和不良出生结果不良，但对女性心血管发病的影响 产后时期尚不清楚。响应RFA-MD-20-800'解决母亲的种族差异 死亡率和发病率”，拟议的研究检查在产前压力调节中的个体差异为 一种生物学途径，早期和慢性压力暴露会影响产后CVD风险 黑人妇女。该研究还基于越来越多的证据表明饮食多不饱和脂肪酸 （PUFA）与压力反应性降低和CVD风险有关，以及我们自己与黑人妇女的工作 支持他们的效用，作为怀孕期间干预的可修改目标。那，我们将探索 产前PUFA水平对生命周期应力与产后CVD风险之间关联的保护作用。 匹兹堡女孩研究（PGS），一项为期20年的纵向研究，开始对压力的年度评估 童年的暴露提供了一个前所未有的机会来阐明围角cvd的表型 风险与终生压力的关系。我们建议从PG招募黑人孕妇（n = 400）， 收集CVD风险的生物行为测量（即脂质，血糖，血压，肥胖，饮食，吸烟 和活动）和产后2、12和24个月的炎症标记。这些新数据将链接到 现有的PGS数据有关先入和产前CVD生物行为标记，终生应力暴露和 产前应力调节以解决黑人妇女之间以下特定目标：（1）阐明外围 与生活压力有关的CVD风险的表型； （2）检查产前应力调节对 产后CVD风险； （3）探索产前PUFA对CVD风险的调节作用。提议 纵向研究基于多学科调查团队的先前工作，并将提供第一个 严格检查黑人妇女CVD风险的周围表型。实现既定目标 将为风险的因果模型提供信息，并产生关键知识以优化的时间和新目标 因为，干预措施减少了母体心血管发病率的持续种族分布。