Preconception contributors to severe maternal morbidity in black and white women

摘要 不良妊娠结局（APO），包括妊娠期高血压疾病、早产 出生和妊娠期糖尿病与短期和长期心血管风险相关， 妈妈们这些关联的紧迫性被一种“无法解释的流行病”所放大， 年轻成年女性（35至55岁）的CVD风险增加（参考文献; Vaccarino，Circulation 2019）。 这些心血管疾病的趋势与无法解释的严重孕产妇发病率（SMM）的增加相吻合， 死亡率在美国，主要原因是心血管性质。（Creanga 2017）进一步 使年轻成年女性心血管健康恶化的趋势更加复杂的是， 深刻而持久的种族差异，黑人妇女有心血管疾病和严重 孕产妇发病率比白色女性高2至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因素 风险和SMM，但迄今为止，这些还没有被研究，在一个全面的和协同的 了解SMM中种族差异的前兆和贡献者。海关将继续执行严厉 NHLBI资助的研究，女性早产和CVD的共同前因（R21 HL 145419）， 能够解开这些问题它还提供了一个独特的机会， * 扩大对孕产妇死亡和孕产妇严重发病的主要原因的研究， 为了加强循证护理和预防战略， 健康CARDIA研究在2，787名女性（50%）中进行了多达9次面对面检查 黑人），其中1，362人从基线到30年随访时分娩了2，389人 考试（1985-2015年）。有大量关于血压、血脂、血脂、血糖、血脂水平的纵向数据， 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。 独特的是，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起来，对来自两个地区的900名CARDIA女性进行研究。 在怀孕前后。我们假设心脏代谢、炎症和 怀孕前社会压力因素趋同， 严重的孕产妇发病率和过早的心血管疾病。评估孕前生物行为 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法。

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.