Continuation of the NuMoM2b Heart Health Study

NuMoM2b 心脏健康研究的延续

基本信息

批准号：
10288873
负责人：
Philip Greenland
金额：
$ 39.75万
依托单位：
RESEARCH TRIANGLE INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-02-15 至 2027-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10288873
关键词：
37 weeks gestation Academic Medical Centers Address Administrative Supplement Adverse event Affect Aging Alzheimer&apos s disease related dementia Ancillary Study Back Biological Markers Brain Brain imaging Cardiac health Cardiovascular system Case-Control Studies Cerebrovascular Circulation Cerebrovascular Disorders Child Clinical Cognition Conceptions Data Dementia Development Discipline of obstetrics Eclampsia Enrollment Fetal Growth Retardation Funding Future Gestational Age Goals Grant Iatrogenesis Impaired cognition Intervention Lacunar Infarctions Life Live Birth Longitudinal cohort study Magnetic Resonance Imaging Maternal-fetal medicine Measures Monitor Mothers National Heart, Lung, and Blood Institute Neurocognitive Nulliparity Outcome Study Participant Persons Phenotype Pilot Projects Play Population Pre-Eclampsia Pregnancy Pregnancy Outcome Premature Birth Prevention strategy Prospective cohort Recording of previous events Research Personnel Resources Risk Role Small for Gestational Age Infant Structure United States National Institutes of Health Virulence Factors Visit White Matter Hyperintensity Woman adjudicate adverse pregnancy outcome cardiovascular risk factor cerebrovascular clinical research site cohort dementia risk experience falls high risk indexing infrastructure development interdisciplinary collaboration middle age pregnancy hypertension primary outcome prospective sex stillbirth vascular cognitive impairment and dementia vascular risk factor white matter

项目摘要

PROJECT SUMMARY/ABSTRACT Pregnancy-related factors may play an important and underrecognized role in the development of vascular contributions to cognitive impairment and dementia (VCID) in women. VCID is now recognized as a key pathogenic factor in Alzheimer's disease and related dementias (ADRD) and represents a promising target for intervention. Preeclampsia and other adverse pregnancy outcomes (APOs) such as gestational hypertension, preterm delivery, and fetal growth restriction affect up to one in five pregnancies and are associated with future maternal cardiovascular and cerebrovascular risk. However, the impact of APOs on maternal VCID remains unexamined. Most existing women's aging cohorts lack rigorously phenotyped, prospectively collected pregnancy data, and the impact of maternal factors that may predispose to both APOs and VCID is not well understood. From 2010-2013, the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) enrolled a diverse cohort of 10,038 healthy women at eight U.S. academic medical centers, who were followed from early in conception through the delivery of their first child. Several years later, the nuMoM2b Heart Health Study (nuMoM2b-HHS) brought back 4,508 nuMoM2b participants for a second study wave, to characterize subsequent pregnancy outcomes and accumulation of cardiovascular risk factors following pregnancy. A third study wave of in-person visits will begin in early 2022. With this administrative supplement, we propose to conduct neurocognitive assessments and perform brain magnetic resonance imaging (MRI) on 20 women who had preeclampsia in the index pregnancy, along with 20 women with no APOs as controls, at two nuMoM2b-HHS clinical sites. The goal of this supplement is to investigate the impact of preeclampsia on maternal VCID in this unique obstetric cohort, through the following specific aims: (1) Determine if women in the nuMoM2b-HHS who experienced preeclampsia in the index pregnancy have increased early markers of VCID on brain MRI 8-11 years after delivery, compared with women with no APOs for either the index or subsequent pregnancies; and (2) Use the NIH Toolbox Cognition Battery to evaluate neurocognitive function, and correlate cognition with brain MRI findings, in women in the nuMoM2b-HHS who experienced preeclampsia in their index pregnancies and women without APOs. We hypothesize that women who had preeclampsia in the index pregnancy will have higher white matter hyperintensity volume and lower global cognition scores compared to women with no APOs. By capitalizing on this exceptionally well- phenotyped cohort of middle-aged women, this supplement will allow the nuMoM2b-HHS investigators a rare opportunity to use prospectively collected pregnancy data to investigate the impact of preeclampsia, a sex- specific vascular risk factor, on VCID and ADRD risk. Understanding the effects of preeclampsia on early markers of VCID could help us identify women early in life who are at higher risk of ADRD and develop preventive strategies to thwart the progression of cognitive decline in this population.

项目概要/摘要妊娠相关因素可能在血管发育中发挥着重要但未被充分认识的作用。导致女性认知障碍和痴呆（VCID）的因素。 VCID 现在被识别为密钥阿尔茨海默氏病和相关痴呆症（ADRD）的致病因素，是一个有希望的目标干涉。先兆子痫和其他不良妊娠结局 (APO)，例如妊娠期高血压、早产和胎儿生长受限影响多达五分之一的妊娠，并与未来相关孕产妇心脑血管风险。然而，APO 对母亲 VCID 的影响仍然存在未经审查。大多数现有的女性衰老队列缺乏严格的表型、前瞻性收集妊娠数据以及可能诱发 APO 和 VCID 的母体因素的影响尚不明确明白了。 2010-2013 年未产儿妊娠结局研究：监测准妈妈 (nuMoM2b) 在美国八个学术医疗中心招募了由 10,038 名健康女性组成的多元化队列，她们从受孕早期一直到第一个孩子的分娩。几年后， nuMoM2b 心脏健康研究 (nuMoM2b-HHS) 招募了 4,508 名 nuMoM2b 参与者进行第二项研究波，以表征随后的妊娠结局和心血管危险因素的积累怀孕后。第三波亲自访问研究将于 2022 年初开始。补充，我们建议进行神经认知评估并进行脑磁共振对 20 名在首次妊娠期间患有先兆子痫的女性以及 20 名没有患有先兆子痫的女性进行了成像 (MRI) APO 作为对照，位于两个 nuMoM2b-HHS 临床中心。本补充的目的是调查影响通过以下具体目标，在这个独特的产科队列中降低先兆子痫对孕产妇 VCID 的影响：(1) 确定 nuMoM2b-HHS 中在指数妊娠期间经历过先兆子痫的女性是否患有与没有 APO 的女性相比，产后 8-11 年脑 MRI 上的 VCID 早期标志物增加对于初次怀孕或随后的怀孕； (2) 使用 NIH Toolbox Cognition Battery 来评估 nuMoM2b-HHS 中女性的神经认知功能，并将认知与脑 MRI 结果相关联在初次怀孕期间经历过先兆子痫的女性以及没有 APO 的女性。我们假设女性妊娠期患有先兆子痫的人白质高信号体积较高，而白质高信号体积较低。与没有 APO 的女性相比，整体认知得分。通过充分利用这一优势中年女性表型队列，这种补充剂将使 nuMoM2b-HHS 研究人员获得罕见的有机会使用前瞻性收集的妊娠数据来调查先兆子痫的影响，子痫前期是一种性别因素特定血管危险因素，关于 VCID 和 ADRD 风险。了解先兆子痫对早期的影响 VCID 标记可以帮助我们在生命早期识别哪些女性患有 ADRD 风险较高，并发展为 ADRD 阻止该人群认知能力下降的预防策略。