Arterial stiffness in mother/infant dyads: Life course approach to prevent cardiovascular disease

母婴二人的动脉僵化：预防心血管疾病的生命全程方法

基本信息

批准号：
10182318
负责人：
Kim A Boggess
金额：
$ 69.38万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-01 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10182318
关键词：
Address Adult Affect Age Aging Biological Biological Markers Biological Process Biological Specimen Banks Birth Blood Pressure Blood Vessels Cardiology Cardiovascular Diseases Cardiovascular system Cause of Death Characteristics Child Childhood Complex Data Diet Disease Early Diagnosis Enrollment Epigenetic Process Ethnic Origin Exercise Family Female Fetal Growth Retardation Future Gestational Age Gestational Diabetes Glycosylated hemoglobin A Goals Growth Gynecologist Healthcare High Risk Woman High-Risk Pregnancy Infant Inflammatory Interdisciplinary Study Interleukin-6 Intervention Knowledge Labor Onset Latina Life Life Cycle Stages Life Style Link Lipids Longitudinal Studies Measures Medical Mothers Multicenter Studies National Heart, Lung, and Blood Institute Not Hispanic or Latino Obesity Patients Physiologic pulse Physiology Postpartum Period Postpartum Women Pre-Eclampsia Pregnancy Pregnant Women Prenatal care Prevention Prevention strategy Primary Prevention Proteomics Public Health Publishing Pulse Rates Questionnaires Race Risk Factors Sex Differences Socioeconomic Status Sports Testing Time Vascular Diseases Weight Woman Women&apos s Health Workplace adiponectin adverse outcome adverse pregnancy outcome arterial stiffness cardiometabolism cardiovascular disorder epidemiology cardiovascular disorder risk cohort data repository early childhood ethnic difference evidence base experience health care availability healthy pregnancy high risk in utero innovation maternal outcome microbiome modifiable risk multidisciplinary neighborhood safety obstetric care offspring perinatal outcomes postnatal postpartum care pregnancy hypertension prevent primary outcome prospective racial and ethnic racial difference resilience risk prediction risk stratification screening sex social success

项目摘要

ABSTRACT Cardiovascular disease (CVD) is the leading cause of death for U.S women, annually killing >400,000 women. Compared to whites, non-Hispanic Black and Latina women are at higher CVD risk. Despite the burden of CVD in women, risk factors specific to women are understudied and thus not considered in current CVD risk prediction or prevention strategies. Early detection of subclinical disease is key to CVD risk stratification and prevention. Since prenatal and postpartum care is the sole health care access point for most U.S. women, pregnancy represents a critical opportunity to measure CVD risk and implement innovative strategies to address this critical gap in women’s health care. Furthermore, CVD risk factor trajectories begin in utero and in early life, so pregnancy is also an opportunity to identify CVD risk in children. Our long-range goal is to identify and disseminate obstetric care practices that mitigate CVD risk for women and their children. The objective of this prospective, multicenter study is to estimate CVD risk in healthy and medically complicated pregnant women and their infants. We will also examine the relationships among personal, social, and ecological factors and CVD risk for 3 years postpartum. Our primary outcomes are maternal and infant central pulse wave velocity (PWV), a validated measure of arterial stiffness (vascular aging) that predicts CVD, independent of other established CVD risk factors. We will enroll a cohort 840 pregnant women of diverse race/ethnicity and socioeconomic status: 420 healthy and 420 women with preeclampsia, gestational diabetes, and/or suspected fetal growth restriction. We will measure maternal and infant PWV, cardio-metabolic (e.g., blood pressure, lipids, adiposity, HbA1c) and inflammatory (e.g., hs-CRP, IL-6, adiponectin) markers of CVD risk, and assess personal, social, and ecological factors at 34-40 weeks’ gestation, delivery, 6 months, 18 months, and 3 years. The study aims are the following: 1) Measure arterial stiffness by PWV during and after pregnancy; 2) Measure infant/child PWV following healthy and complicated pregnancies; and 3) Identify maternal and infant modifiable risk factors associated with CVD risk measured by PWV. To date, no studies have longitudinally measured CVD risk in pregnant women and their infants, nor ascertained the effect of biologic, personal, social, and/or ecological factors on CVD risk. Using a noninvasive measure of arterial stiffness, we propose to determine CVD risk in a cohort of mother-infant dyads. Our interdisciplinary study team of experts in CVD, high-risk pregnancy, exercise and sports physiology, CVD epidemiology, public health, and cardiology are well poised to complete the proposed aims by using a synthesis of expertise to achieve our common, shared goal of mitigate CVD risk for women and their children. We are proposing an innovative paradigm shift in the goals of prenatal care to use pregnancy as a time in a woman’s life, particularly if she is at high risk for CVD, to identify and mitigate early markers of CVD for herself and her offspring.

抽象的心血管疾病 (CVD) 是美国女性死亡的主要原因，每年导致超过 40 万名女性死亡。与白人相比，非西班牙裔黑人和拉丁裔女性的 CVD 风险更高，尽管有 CVD 负担。在女性中，女性特有的危险因素尚未得到充分研究，因此在当前的 CVD 风险中并未考虑预测或预防策略。亚临床疾病的早期发现是 CVD 风险分层和预防的关键。由于产前和产后护理是大多数美国女性唯一的医疗保健途径，怀孕是衡量 CVD 风险和实施创新策略的重要机会此外，CVD 危险因素的轨迹始于子宫内和体内。生命早期，因此怀孕也是识别儿童 CVD 风险的一个机会。确定并传播可降低妇女及其子女的 CVD 风险的产科护理实践。这项前瞻性、多中心研究的目的是评估健康和患有医学复杂疾病的人的 CVD 风险我们还将研究孕妇及其婴儿之间的关系。产后 3 年的生态因素和 CVD 风险我们的主要结局是孕产妇和婴儿。中心脉搏波速度 (PWV)，一种经过验证的动脉僵硬度（血管老化）测量方法，可预测 CVD，独立于其他已确定的 CVD 危险因素，我们将招募 840 名不同背景的孕妇组成的队列。种族/民族和社会经济地位：420 名健康人和 420 名患有先兆子痫、妊娠糖尿病、和/或怀疑胎儿生长受限。我们将测量母婴 PWV、心脏代谢（例如， CVD 的血压、血脂、肥胖、HbA1c）和炎症（例如 hs-CRP、IL-6、脂联素）标志物风险，并评估妊娠 34-40 周、分娩、6 个月、18 岁时的个人、社会和生态因素研究目标如下： 1) 在期间和之后通过 PWV 测量动脉硬度。怀孕；2) 健康和复杂怀孕后测量婴儿/儿童 PWV；确定与 PWV 测量的 CVD 风险相关的母婴可改变危险因素。研究纵向测量了孕妇及其婴儿的 CVD 风险，但未确定其影响使用非侵入性动脉测量方法评估生物、个人、社会和/或生态因素对 CVD 风险的影响。为了确定母婴群体的 CVD 风险，我们提出了跨学科研究。心血管病、高危妊娠、运动和运动生理学、心血管病流行病学、公众健康和心脏病学已准备好通过综合专业知识来完成拟议的目标实现我们共同的目标，即降低妇女及其子女的 CVD 风险。产前护理目标的创新范式转变，将怀孕视为女性生命中的一段时期，特别是如果她患有 CVD 风险较高，则为自己和她的后代识别并及早减轻 CVD 标志物。