Cardiovascular Health After Placental Abruption (CHAP)

胎盘早剥后的心血管健康 (CHAP)

• 批准号: 10238171
• 负责人: Cande V. Ananth
• 金额: $ 68.65万
• 依托单位: RBHS-ROBERT WOOD JOHNSON MEDICAL SCHOOL
• 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 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10238171
• 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 胎盘早剥是一种产科并发症，被定义为胎盘过早分离，尽管其病因难以捉摸。 它被认为是母胎急性刺激——缺血、炎症和氧化应激的结果 界面 - 与蜕膜动脉破裂有关，导致（过早）胎盘分离。 胎早剥以及孕产妇和新生儿的长期心血管和出血/血栓性脑血管事件 我们将研究心脏骤停对心血管疾病发生率的长期影响。 我们还将调查妇女及其子女的脑血管发病率和死亡率的关系。 胎盘早剥的临床分类（轻度和重度形式）、基于连续妊娠的胎盘早剥的风险，以及 双胎妊娠早剥与心脑血管事件发生率的关系我们将进行因果关系分析。 中介分析，以评估这些关联可能通过以下方式介导的程度：（i）早产和 (ii) 小于胎龄儿的出生 我们将通过胎盘早剥的临床分类进行分析并估计胎龄儿。 校正后的中介程度（社会人口特征，包括母亲） 吸烟、合并症和产科事件）以及无法测量的混杂因素是其中的一个独特之处。 项目将通过支持向量机和深度学习算法的应用来识别 最后，我们将检查胎盘早剥以及心脑血管死亡率和发病率高风险的女性。 母亲种族/族裔和社会经济地位是否是两者之间关联的影响测量修正因素 我们建议通过大规模的研究来实现这些目标。 基于人群的流行病学研究，利用心肌梗塞数据采集系统 (MIDAS) 的数据， 新泽西州总统数据库记录了新泽西州所有非联邦急症护理医院收治的所有患有 CVD 诊断的患者， 长达 30 年的纵向随访将与新泽西州胎儿死亡和活产联系起来。 1980 年至 2017 年期间婴儿死亡数据以及相关孕产妇和新生儿住院数据，以创建其中一项 美国最大、最全面的数据库，用于评估妊娠期哨兵事件影响的程度 该项目将为解决妇女和儿童晚年健康面临的持久风险提供前所未有的机会。 妇女产后期间的公共卫生、政策影响和临床筛查建议 关于心脑血管疾病的风险易感性。