Preconception contributors to severe maternal morbidity in black and white women

摘要 不良妊娠结局(APO)，包括妊娠高血压疾病、早产 出生和妊娠期糖尿病与心血管疾病的短期和长期风险有关 母亲们。这些联系的紧迫性因一种无法解释的流行病而被放大 年轻成年女性(35岁至55岁)心血管疾病风险增加(参考《瓦卡里诺》，《2019年循环》)。 这些心血管疾病的趋势与严重孕产妇发病率(SMM)和 美国的死亡率，主要原因是心血管疾病。(Creanga 2017)进一步 使年轻成年女性心血管健康恶化的这些趋势变得复杂的是 深刻而持久的种族差异，黑人妇女患心血管疾病和严重心血管疾病的比率 产妇发病率是白人妇女的2到3倍(Peterson 2019)。社会决定因素 包括压力、歧视和获得护理在内的健康问题也是心血管疾病的已知诱因。 风险和SMM，但到目前为止，还没有对它们进行全面和协同的研究 了解SMM中种族差异的前兆和贡献者的时尚。我们正在进行的 NHLBI资助的研究，分享了女性早产和心血管疾病的先兆(R21HL145419)， 正准备独一无二地理清这些问题。它还提供了一个独特的机会来 扩大对#年孕产妇死亡和严重孕产妇发病率的主要原因的研究 以加强循证护理和预防战略，改善孕产妇 健康。CARDIA的这项研究对2787名女性(50%)进行了多达9次面对面检查 黑人)，其中1,362人从基线到第30年的后续行动分娩了2,389人 考试(1985-2015)。有大量关于血压、血脂、血糖、 心脏结构、肥胖、生活方式、代谢性疾病和亚临床动脉粥样硬化。 独一无二的是，这些检查包括关于压力、健康的社会决定因素和 歧视。我们建议将这些特征集合在一起，研究900名来自 怀孕前和怀孕后。我们假设心脏新陈代谢、炎症和 怀孕前的社会压力源汇聚在一起，导致了 严重的孕产妇发病率和早产儿心血管疾病。评估怀孕前的生物行为 标记物将为妊娠相关疾病的病理生理学提供新的见解 以及确定减轻育龄妇女心血管疾病的方式。

ABSTRACT Adverse pregnancy outcomes (APO), including hypertensive disorders of pregnancy, preterm birth, and gestational diabetes, are associated with short- and long-term cardiovascular risk in mothers. The urgency of these associations is amplified by an `unexplained epidemic' of increased CVD risk among young adult women (age 35 to 55) (ref; Vaccarino, Circulation 2019). These CVD trends coincide with unexplained increases in severe maternal morbidity (SMM) and mortality in the U.S, the dominant cause being cardiovascular in nature. (Creanga 2017) Further complicating these trends of deteriorating cardiovascular health in young adult women are profound and persistent race disparities, with black women having rates of CVD and severe maternal morbidity 2 to 3 times higher than white women (Peterson 2019). Social determinants of health including stress, discrimination and access to care are also known contributors to CVD risk and SMM, but to date these have not been studied in a comprehensive and synergistic fashion to understand precursors and contributors to racial disparities in SMM. Our on-going NHLBI-funded study, Shared antecedents to preterm birth and CVD in women (R21HL145419), is uniquely poised to disentangle these questions. It also provides a unique opportunity to expand research on the leading causes of maternal mortality and severe maternal morbidity in order to strengthen evidence-based care and prevention strategies and improve maternal health. The CARDIA study has conducted up to 9 in-person exams among 2,787 women (50% Black), of whom 1,362 delivered 2,389 births from baseline and up to the year 30 follow-up exam (1985-2015). There are extensive longitudinal data on blood pressure, lipids, glycemia, cardiac structure, adiposity, lifestyle, metabolic diseases, and subclinical atherosclerosis. Uniquely, these exams include longitudinal data on stress, social determinants of health and discrimination. We propose to assemble these features to study 900 CARDIA women from both before and after pregnancies. We hypothesize that cardiometabolic, inflammatory and social stressors prior to pregnancy converge and contribute to racial disparities in severe maternal morbidity and premature CVD. Assessing pre-conception bio-behavioral markers will provide novel insights into the pathophysiology of pregnancy-associated morbidity as well as identify modalities to mitigate CVD in women of reproductive age.