Pregnancy as a Window to Future Cardiovascular Health

怀孕是未来心血管健康的窗口

• 批准号: 8576079
• 负责人: SAMUEL I. PARRY
• 金额: $ 4.72万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-24 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8576079
• 关键词: Address; Behavioral; Birth; Blood; Blood Pressure; Breast Feeding; Cardiovascular Diseases; Cardiovascular system; Clinical; Data; Data Collection; Databases; Development; Diet; Dyslipidemias; Enrollment; Environmental Risk Factor; Epidemiologic Studies; Ethnic Origin; Evaluation; Exposure to; Funding; Future; Gestational Diabetes; Goals; Health; Heart Diseases; Human Resources; Hypertension; Hypertension induced by pregnancy; Incidence; Inflammation; Interview; Knowledge; Life; Maternal Health; Measurement; Mediating; Medical Records; Metabolic; Monitor; Mothers; National Heart, Lung, and Blood Institute; National Institute of Child Health and Human Development; Outcome; Outcome Study; Parents; Pattern; Phenotype; Physical activity; Physiological; Placenta; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Prevention strategy; Principal Investigator; Psychosocial Stress; Questionnaires; Race; Recording of previous events; Recruitment Activity; Risk; Risk Factors; Sampling; Second Pregnancy Trimester; Self-Administered; Sleep; Sleep Apnea Syndromes; Small for Gestational Age Infant; Smoking; Socioeconomic Status; Talents; Testing; Time; Tissue Banking; Tissue Banks; Tobacco smoke; Training; Ultrasonography; Umbilical Cord Blood; Urine; Weight; Weight Gain; Woman; Women' s Health; cardiovascular disorder risk; cohort; experience; follow-up; glucose metabolism; improved; lipid metabolism; multidisciplinary; nutrition; pregnant; prospective; psychosocial; research clinical testing; screening; social; socioeconomics; stillbirth; vaginal fluid

DESCRIPTION (provided by applicant): Recent epidemiologic studies suggest that women with adverse pregnancy outcomes (APOs), such as preeclampsia, are at increased risk for subsequent cardiovascular diseases. However, prospective data to elucidate the precise relationship between adverse pregnancy outcomes and subsequent cardiovascular disease are lacking. To address this critical knowledge gap, the NHLBI issued a RFA to study pregnancy as a window to future maternal health. In this proposal, a multidisciplinary team with diverse talents and expertise will define the relationship between APOs and markers of cardiovascular disease risk (CVDR) at two years after delivery. This multicenter group will utilize an ethnically, raciall, socioeconomically and geographically diverse cohort of 10,000 nulliparous women enrolled in the NICHD-funded Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The proposed studies are highly leveraged, utilizing the extensive and unique database and tissue bank developed in the parent study in which nulliparous women are evaluated over the course of pregnancy to study the mechanisms for and prediction of APOs. Women enrolled in the nuMoM2b cohort are extremely well phenotyped through prospective data collection, clinical evaluations, and ultrasound assessments, as well as through the use of standardized definitions. Demographic, psychosocial, dietary, physiologic, and outcome information is collected through maternal interviews, self-administered questionnaires, clinical measurements, ultrasounds, and medical record abstraction by trained personnel. Samples of maternal blood, urine, and cervico-vaginal fluid over pregnancy and cord blood and placenta at delivery are collected and banked. All women complete two sleep questionnaires and over 3,600 are recruited to perform objective overnight sleep studies at two times during pregnancy. Women participating in the nuMoM2b parent study will be assessed for evidence of CVDR, including sleep disordered breathing (SDB), at two to three years postpartum. APOs in subsequent pregnancies also will be assessed. These studies will characterize the relationship between APOs and CVDR, identify first pregnancy profiles that portend subsequent CVDR, determine associations between SDB during the first pregnancy and subsequent CVDR, and identify modifiable factors that mediate the associations between CVDR and APOs in the first and subsequent pregnancy. This will allow for the development of strategies to modify these CVDR factors and to improve the health of women suffering APOs. Relevance: NICHD is currently conducting a large study that looks for tests to identify the risk of developing pregnancy problems in women who are pregnant for the first time. In this new study, the same women will be tested again at approximately 2 years after they give birth to see if there are early signs of heart disease in those who had problem pregnancies. Information from this follow-up study will be used to improve the health of women using their experiences during pregnancy.

描述（由申请人提供）：最近的流行病学研究表明，患有不良妊娠结局（APO）的妇女（例如先兆子痫）的风险增加了随后的心血管疾病。然而，缺乏不良妊娠结局与随后的心血管疾病之间的精确关系的前瞻性数据。为了解决这个关键的知识差距，NHLBI发布了RFA，以研究怀孕，以此作为未来孕产妇健康的窗口。在此提案中，一个具有多种才能的多学科团队 专业知识将在分娩两年后定义APO与心血管疾病风险（CVDR）的标记之间的关系。这个多中心群体将利用一个种族，种族，社会经济和地理上多样化的队列，其中包括10,000名无效的妇女，该妇女参加了NICHD资助的无效怀孕结果研究：监测准母亲（Numom2B）。 拟议的研究具有高度杠杆作用，利用了父母研究中开发的广泛而独特的数据库和组织库，在该研究中，在怀孕过程中评估了无效的妇女，以研究APOS的机制和预测。通过前瞻性数据收集，临床评估和超声评估以及使用标准化的定义，可以很好地表现出参加NUMOM2B队列的妇女。人群，社会心理，饮食，生理和结果信息是通过孕产妇访谈，自我管理的问卷，临床测量，超声检查和训练有素的人员抽象的方法来收集的。孕妇的血液，尿液和子宫颈流体的样品在妊娠中，脐带血和胎盘分娩时被收集和储存。所有妇女填写了两份睡眠问卷，并招募了3600多个妇女，以在怀孕期间两次进行客观的过夜睡眠研究。 参与NUMOM2B父母研究的妇女将在产后两到三年的情况下评估CVDR的证据，包括睡眠不足的呼吸（SDB）。随后的怀孕中的APO也将进行评估。这些研究将表征APOS和CVDR之间的关系，确定第一个妊娠轮廓，这些妊娠轮廓预留了随后的CVDR，确定第一次妊娠期间SDB与随后的CVDR之间的关联，并确定可修改的因素，以介导第一次及后怀孕期间CVDR和APO之间的关联。这将允许制定策略来修改这些CVDR因素并改善遭受APO的妇女的健康。 相关性：NICHD目前正在进行一项大型研究，该研究正在寻找测试以确定的风险 第一次怀孕的妇女患妊娠问题。在这项新研究中，同一妇女将在出生后大约2年，以查看患有问题怀孕的患者是否有早期的心脏病迹象。这项后续研究的信息将用于利用怀孕期间的经验来改善妇女的健康。