Continuation of the NuMoM2b Heart Health Study

NuMoM2b 心脏健康研究的延续

• 批准号: 10288873
• 负责人: Philip Greenland
• 金额: $ 39.75万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-15 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10288873
• 关键词: 37 weeks gestation; Academic Medical Centers; Address; Administrative Supplement; Adverse event; Affect; Aging; Alzheimer' s disease related dementia; Ancillary Study; Back; Biological Markers; Brain; Brain imaging; Cardiac health; Cardiovascular system; Case-Control Studies; Cerebrovascular Circulation; Cerebrovascular Disorders; Child; Clinical; Cognition; Conceptions; Data; Dementia; Development; Discipline of obstetrics; Eclampsia; Enrollment; Fetal Growth Retardation; Funding; Future; Gestational Age; Goals; Grant; Iatrogenesis; Impaired cognition; Intervention; Lacunar Infarctions; Life; Live Birth; Longitudinal cohort study; Magnetic Resonance Imaging; Maternal-fetal medicine; Measures; Monitor; Mothers; National Heart, Lung, and Blood Institute; Neurocognitive; Nulliparity; Outcome Study; Participant; Persons; Phenotype; Pilot Projects; Play; Population; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Prevention strategy; Prospective cohort; Recording of previous events; Research Personnel; Resources; Risk; Role; Small for Gestational Age Infant; Structure; United States National Institutes of Health; Virulence Factors; Visit; White Matter Hyperintensity; Woman; adjudicate; adverse pregnancy outcome; cardiovascular risk factor; cerebrovascular; clinical research site; cohort; dementia risk; experience; falls; high risk; indexing; infrastructure development; interdisciplinary collaboration; middle age; pregnancy hypertension; primary outcome; prospective; sex; stillbirth; vascular cognitive impairment and dementia; vascular risk factor; white matter

PROJECT SUMMARY/ABSTRACT Pregnancy-related factors may play an important and underrecognized role in the development of vascular contributions to cognitive impairment and dementia (VCID) in women. VCID is now recognized as a key pathogenic factor in Alzheimer's disease and related dementias (ADRD) and represents a promising target for intervention. Preeclampsia and other adverse pregnancy outcomes (APOs) such as gestational hypertension, preterm delivery, and fetal growth restriction affect up to one in five pregnancies and are associated with future maternal cardiovascular and cerebrovascular risk. However, the impact of APOs on maternal VCID remains unexamined. Most existing women's aging cohorts lack rigorously phenotyped, prospectively collected pregnancy data, and the impact of maternal factors that may predispose to both APOs and VCID is not well understood. From 2010-2013, the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) enrolled a diverse cohort of 10,038 healthy women at eight U.S. academic medical centers, who were followed from early in conception through the delivery of their first child. Several years later, the nuMoM2b Heart Health Study (nuMoM2b-HHS) brought back 4,508 nuMoM2b participants for a second study wave, to characterize subsequent pregnancy outcomes and accumulation of cardiovascular risk factors following pregnancy. A third study wave of in-person visits will begin in early 2022. With this administrative supplement, we propose to conduct neurocognitive assessments and perform brain magnetic resonance imaging (MRI) on 20 women who had preeclampsia in the index pregnancy, along with 20 women with no APOs as controls, at two nuMoM2b-HHS clinical sites. The goal of this supplement is to investigate the impact of preeclampsia on maternal VCID in this unique obstetric cohort, through the following specific aims: (1) Determine if women in the nuMoM2b-HHS who experienced preeclampsia in the index pregnancy have increased early markers of VCID on brain MRI 8-11 years after delivery, compared with women with no APOs for either the index or subsequent pregnancies; and (2) Use the NIH Toolbox Cognition Battery to evaluate neurocognitive function, and correlate cognition with brain MRI findings, in women in the nuMoM2b-HHS who experienced preeclampsia in their index pregnancies and women without APOs. We hypothesize that women who had preeclampsia in the index pregnancy will have higher white matter hyperintensity volume and lower global cognition scores compared to women with no APOs. By capitalizing on this exceptionally well- phenotyped cohort of middle-aged women, this supplement will allow the nuMoM2b-HHS investigators a rare opportunity to use prospectively collected pregnancy data to investigate the impact of preeclampsia, a sex- specific vascular risk factor, on VCID and ADRD risk. Understanding the effects of preeclampsia on early markers of VCID could help us identify women early in life who are at higher risk of ADRD and develop preventive strategies to thwart the progression of cognitive decline in this population.

项目总结/摘要 妊娠相关因素可能在血管发生发展中起重要作用，但未被充分认识。 导致女性认知障碍和痴呆（VCID）。VCID现在被识别为密钥 阿尔茨海默病和相关痴呆症（ADRD）的致病因子，并代表了一个有前途的目标， 干预先兆子痫和其他不良妊娠结局（APO），如妊娠期高血压， 早产和胎儿生长受限影响多达五分之一的怀孕，并与未来的 母亲的心血管和脑血管风险。然而，APO对母体VCID的影响仍然存在， 未经检查大多数现有的女性衰老队列缺乏严格的表型，前瞻性收集 妊娠数据，以及可能导致APO和VCID的母体因素的影响并不清楚 明白2010-2013年，未产妊娠结局研究：监测准妈妈 （nuMoM 2b）在美国8个学术医学中心招募了10，038名健康女性， 从怀孕早期到第一个孩子的出生都被跟踪。几年后， nuMoM 2b心脏健康研究（nuMoM 2b-HHS）带回了4，508名nuMoM 2b参与者进行第二项研究 波，以表征随后的妊娠结局和心血管危险因素的累积 怀孕后。第三波研究将于2022年初开始进行。与此行政 作为补充，我们建议进行神经认知评估和进行脑磁共振检查， 对20名在指数妊娠中有先兆子痫的妇女进行了MRI检查，沿着20名没有先兆子痫的妇女， 作为对照的APO，在两个nuMoM 2b-HHS临床中心。本增刊的目的是调查 在这个独特的产科队列中，通过以下具体目标，研究先兆子痫对孕产妇VCID的影响：（1） 确定nuMoM 2b-HHS中在首次妊娠中经历先兆子痫的女性是否 与无APO的女性相比，分娩后8-11年脑MRI上VCID的早期标志物增加 对于指数或随后的怀孕;和（2）使用美国国立卫生研究院认知电池，以评估 在nuMoM 2b-HHS的女性中， 在指数妊娠和无APO的妇女中经历先兆子痫。我们假设女性 在指数妊娠中患有先兆子痫的孕妇，其白色高信号体积较高， 与没有APO的女性相比，总体认知得分。把这一点很好地利用起来- 表型队列的中年妇女，这种补充将使nuMoM 2b-HHS研究人员罕见的 有机会使用前瞻性收集的妊娠数据来研究先兆子痫的影响， 特定血管风险因素对VCID和ADRD风险的影响。了解先兆子痫对早期妊娠的影响 VCID的标志物可以帮助我们在生命早期识别出ADRD风险较高的女性， 预防策略，以阻止这一人群认知能力下降的进展。