Cardiovascular Health After Placental Abruption (CHAP)

胎盘早剥后的心血管健康 (CHAP)

• 批准号: 10444976
• 负责人: Cande V. Ananth
• 金额: $ 70.45万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-13 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10444976
• 关键词: Abruptio Placentae; Acute; Acute myocardial infarction; Address; Adult; Affect; Arteries; Attention; Birth; Cardiovascular Diagnostic Techniques; Cardiovascular Diseases; Cardiovascular system; Cerebrovascular Disorders; Cessation of life; Characteristics; Child; Child Health; Chronic Disease; Classification; Clinical; Congestive Heart Failure; Data; Databases; Discipline of obstetrics; Disease; Educational workshop; Ethnic Origin; Etiology; Event; Fetal Death; Fetal Growth Retardation; Frequencies; Future; Gestational Age; Gestational Diabetes; Goals; Health Policy; Hemorrhage; High Risk Woman; Hospitalization; Hospitals; Infant Health; Infant Mortality; Inflammation; Ischemia; Life; Link; Live Birth; Machine Learning; Maternal-Fetal Exchange; Measures; Mediating; Mediation; Medical; Morbidity - disease rate; Myocardial Infarction; Myocardial Ischemia; National Heart, Lung, and Blood Institute; National Institute of Child Health and Human Development; New Jersey; Newborn Infant; Outcome; Oxidative Stress; Patients; Perinatal mortality demographics; Placenta; Pre-Eclampsia; Predisposition; Pregnancy; Premature Birth; Public Health; Pulmonary Embolism; Race; Recommendation; Recurrence; Reporting; Risk; Risk Factors; Rupture; Sentinel; Severities; Small for Gestational Age Infant; Socioeconomic Status; Stimulus; Stroke; System; Twin Multiple Birth; United States National Institutes of Health; Uterus; Vision; Woman; Women' s Health; acute care; base; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; cerebrovascular; comorbidity; data acquisition; deep learning algorithm; epidemiology study; follow-up; health of the mother; high risk; hypertensive heart disease; improved; infant death; insight; interest; maternal cigarette smoking; maternal risk; mortality; obstetrical complication; policy implication; population based; premature; screening guidelines; sociodemographics; stillbirth; support vector machine; thrombotic

Abstract Placental abruption is an obstetrical complication defined as premature placental separation. Despite its elusive etiology, it is believed to be the consequence of acute stimuli – ischemia, inflammation, and oxidative stress at the maternal‐fetal interface – associated with rupture of the decidual artery, resulting in (premature) placental separation. The study of abruption and maternal and newborn long‐term cardiovascular and hemorrhagic/thrombotic cerebrovascular events is the central focus of the proposed project. We will examine the long‐term impact of abruption on rates of cardiovascular and cerebrovascular morbidity and mortality in women and in their children. We will also investigate the relationship of clinical classification (mild and severe forms) of abruption, risks based on abruption across successive pregnancies, and abruption in twin pregnancies, on rates of cardiovascular and cerebrovascular events. We will undertake a causal mediation analysis to evaluate the extent to which these associations may be mediated through (i) preterm delivery and (ii) small for gestational age births. We will perform this analysis by clinical classification of abruption and estimate the extent of mediation following corrections for both measured (socio‐demographic characteristics, including maternal smoking, comorbid medical conditions, and obstetrical events), and unmeasured confounding. A unique aspect of this project will be to identify, through applications of Support Vector Machines and Deep Learning algorithms, subsets of women at high risk for abruption and cardiovascular and cerebrovascular mortality and morbidity. Finally, we will examine whether maternal race/ethnicity and socioeconomic status are effect measure modifiers of the association between abruption and risks of cardiovascular and cerebrovascular events. We propose to address these aims through a large population‐based epidemiologic study, utilizing data from the Myocardial Infarction Data Acquisition System (MIDAS), a New Jersey statewide database of all patients admitted to all non‐federal acute care hospitals in NJ with a CVD diagnosis, with longitudinal follow‐up of up to 30 years. The MIDAS data will be linked to the NJ fetal death and linked live birth‐ infant death data with associated maternal and newborn hospitalization data between 1980‐2017 to create one of the largest and most comprehensive databases in the US to evaluate the extent to which sentinel events in pregnancy impart lasting risk for women's and children's health later in life. This project will provide unprecedented opportunities to address public health, policy implications and clinical screening recommendations of women during the period following delivery regarding risk susceptibility to cardiovascular and cerebrovascular disease.

抽象的 胎盘破裂是一种产科并发症，定义为过早的胎盘分离。尽管它的病因难以捉摸，但 据信这是急性刺激 - 缺血，感染和氧化应激的结果 界面 - 与决定层破裂有关，导致（过早）分离。研究 出现，母亲和新生儿长期心血管和出血/血栓性脑血管事件是 拟议项目的主要重点。我们将研究突发对心血管率的长期影响 女性及其子女的脑血管发病率和死亡率。我们还将调查 破裂的临床分类（轻度和严重形式），基于成功怀孕的突发的风险以及 双胞胎妊娠的破裂，心血管和脑血管事件的发生率。我们将进行因果关系 调解分析以评估通过（i）早产和 （ii）小针对胎龄。我们将通过破坏的临床分类进行此分析，并估算 校正后的调解程度（社会人口统计学特征，包括母体） 吸烟，合并医疗状况和产科事件）以及无法衡量的混淆。一个独特的方面 项目将通过支持向量机和深度学习算法的应用来识别 妇女出现高风险，心血管和脑血管死亡率和发病率。最后，我们将检查 孕产妇种族/种族和社会经济地位是否是效应的测量修饰符 心血管和脑血管事件的突发和风险。我们建议通过大型目标解决这些目标 基于人群的流行病学研究，使用心肌违规数据采集系统（MIDAS）的数据，A 新泽西州全州数据库的所有患者都接受了新泽西州所有非联邦急性护理医院，并具有CVD诊断， 纵向随访长达30年。 MIDAS数据将与NJ胎儿死亡相关 在1980 - 2017年之间，使用相关母校和新生儿住院数据的婴儿死亡数据创建了其中之一 美国最大，最全面的数据库，以评估怀孕的哨兵事件的程度 妇女和儿童健康的持久风险后来生活。该项目将提供前所未有的机会来解决 分娩后的公共卫生，政策含义和妇女的临床筛查建议 考虑到对心血管和脑血管疾病的风险敏感性。