Reducing Cardiovascular Risk in Women with Hypertension or Diabetes in Pregnancy

降低妊娠期高血压或糖尿病女性的心血管风险

• 批准号: 8309124
• 负责人: Wendy Lynet Bennett
• 金额: $ 13.97万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-20 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8309124
• 关键词: Address; Affect; Behavior; Behavior Therapy; Behavioral; Blood Vessels; Cardiovascular Diseases; Caring; Cause of Death; Chronic Disease; Clinical Research; Clinical Trials Design; Cohort Studies; Conduct Clinical Trials; Data; Data Analyses; Development; Development Plans; Diagnosis; Discipline of obstetrics; Disease; Effectiveness of Interventions; Enabling Factors; Epidemiology; Fellowship; Future; Gestational Diabetes; Glucose Intolerance; Goals; Grant; Health Insurance; Health Surveys; Health behavior; Health behavior change; Healthcare; Heart Diseases; High Prevalence; High Risk Woman; Hypertension; Inflammatory; Insurance; Internal Medicine; Intervention; Lead; Life; Life Style; Long-Term Effects; Medical; Medical Surveillance; Medicine; Mentors; Metabolic; Metabolic syndrome; Minority Groups; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Pattern; Physiological; Population; Postpartum Period; Predisposing Factor; Predisposition; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Preventive; Primary Health Care; Primary Prevention; Principal Investigator; Recommendation; Recruitment Activity; Reinforcing Factor; Research; Research Personnel; Resources; Risk; Risk Factors; Sampling; Science; Stress Tests; Training; United States; Universities; Visit; Woman; abstracting; cardiovascular disorder risk; cardiovascular risk factor; career; career development; clinical research site; design; effective intervention; experience; follow-up; health care service utilization; heart disease risk; high risk; improved; medical schools; men; mortality; professor; programs; prospective; public health relevance; skills

DESCRIPTION (provided by applicant): Women with recent pregnancy complications, such as gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy (HDP), have an increased risk of developing cardiovascular disease (CVD). Pregnancy provides a unique opportunity to identify women with these vascular risk factors earlier in life. Yet, we are missing this window of opportunity, as women are often lost to follow- up postpartum and do not received recommended care. There is a paucity of evidence on how to effectively promote and sustain CVD-preventive health behaviors in this high risk population. The overall objective of the proposed study is to identify barriers to and predictors of CVD-preventive health behaviors, including medical follow-up and healthy lifestyle behaviors, in the postpartum period in women with recent GDM and HDP. Using the PRECEDE-PROCEED model, we will use these findings to develop an interventional study to address the predisposing, enabling and reinforcing factors that influence CVD-preventive health behaviors. Results from this proposal could have broad implications for the development of practical and sustainable strategies to decrease CVD morbidity and mortality in women. The specific aims are to: 1) conduct a retrospective cohort study to describe healthcare utilization patterns and predictors of follow-up medical care in the first year postpartum in women with GDM and/or HDP; 2) conduct a prospective cohort study to determine predictors CVD-preventive behaviors in the first year postpartum in women with GDM and/or HDP; 3) design and carry-out a pilot multilevel educational-behavioral intervention to increase CVD-preventive health behaviors in women with GDM and/or HDP. The candidate is completing a clinical research fellowship in General Internal Medicine (GIM) at Johns Hopkins University School of Medicine and will take an Assistant Professor post at Johns Hopkins in July, 2009. Her primary mentor is Dr. Jeanne Clark, Associate Professor of Medicine and Epidemiology, with extensive experience in mentoring, epidemiology, and the design of clinical trials. Her co-mentor is Dr. David Levine, Professor of Medicine, principal investigator of the NHLBI training grant on behavioral aspects of CVD and an established investigator and mentor. The candidate's long term career goal is to establish an independent research program in the primary prevention of CVD in women. To accomplish this goal, her short term goals involve a career development plan to enhance her skills in longitudinal data analysis, health survey research, health behavior science, and the design and conduct of clinical trials. Results of this proposal will lead to the development of a pilot intervention in years 4 and 5 and an R01 proposal early in year 5 to investigate the effectiveness of an intervention to improve CVD-preventive health behaviors in the postpartum period in women with recent GDM and/or HDP. PUBLIC HEALTH RELEVANCE: Women with recent high blood pressure or diabetes in pregnancy have an increased risk of developing heart disease later in life. However, many women are lost to follow-up after delivery and do not receive recommendations promoting continued medical surveillance and healthy lifestyle changes to reduce their heart disease risk. The purpose of this study is to identify barriers for women to receive medical follow-up care and engage in healthy lifestyle behaviors in the postpartum period, in order to design effective strategies to decrease their risk of heart disease. (End of Abstract)

描述（由申请人提供）：近期怀孕并发症的妇女，例如妊娠糖尿病（GDM）和怀孕中的高血压疾病（HDP），患心血管疾病（CVD）的风险增加了。怀孕提供了一个独特的机会，可以识别生活中患有这些血管危险因素的女性。但是，我们缺少这个机会之窗，因为妇女常常因跟进产后而失去，并且没有接受建议的护理。关于如何有效促进和维持在这种高风险人群中的CVD健康行为的证据很少。拟议的研究的总体目标是在产后在最近的GDM和HDP的女性中确定CVD预防健康行为的障碍和预测因素，包括医疗后续行动和健康的生活方式行为。使用先前的模型，我们将使用这些发现来开发一项介入研究，以解决影响CVD预防健康行为的诱人，启用和增强因素。该提案的结果可能会对制定实践和可持续策略的发展具有广泛的影响，以降低女性CVD发病率和死亡率。具体目的是：1）进行回顾性队列研究，以描述产后第一年的GDM和/或HDP妇女中第一年的医疗保健使用模式和随访医疗保健的预测因素； 2）进行一项前瞻性队列研究，以确定产后第一年的预测性CVD预防性行为对GDM和/或HDP的女性； 3）设计和携带飞行员多层次的教育行为干预措施，以增加GDM和/或HDP女性的CVD预防健康行为。该候选人正在约翰·霍普金斯大学医学院完成一项临床研究奖学金（GIM），并于2009年7月在约翰·霍普金斯（Johns Hopkins）任职。和流行病学，在指导，流行病学和临床试验设计方面具有丰富的经验。她的同事是医学教授，NHLBI培训培训赠款的首席研究员戴维·莱文（David Levine）博士，以及既定的研究员和导师。候选人的长期职业目标是建立一项独立的研究计划，以预防女性CVD。为了实现这一目标，她的短期目标涉及一项职业发展计划，以提高她在纵向数据分析，健康调查研究，健康行为科学以及临床试验的设计和行为方面的技能。该提案的结果将导致在第4和5年度的开发试点干预措施，以及第五年初的R01提案，以调查在产后在最近的GDM和GDM和GDM妇女中改善CVD预防健康行为的干预措施的有效性。 /或HDP。 公共卫生相关性： 最近患有高血压或糖尿病的妇女在以后的生活中患心脏病的风险增加。但是，许多妇女分娩后失去了随访，并且没有收到建议，促进医疗监视和健康的生活方式改变以降低其心脏病风险。这项研究的目的是确定妇女在产后时期接受医疗后续护理并从事健康生活方式行为的障碍，以设计有效的策略以降低其心脏病的风险。 （抽象的结尾）