Longitudinal Changes in Weight and Biology in the Pregnancy-Postpartum Period and Subsequent Cardiometabolic Risk

怀孕标志着一个极端的生理变化时期，因为母体的免疫，内分泌和代谢 系统迅速适应以维持生长的胎儿。人们通常认为，这些怀孕引起的 改变（例如，血脂升高、胰岛素抵抗、体重增加）在产后6个月逆转。然而，证据 这表明，对于一些妇女的生理变化持续存在，并可能赋予长期的风险，慢性 心血管疾病（CVD）。例如，我们已经证明， 导致CVD风险的标志物可能在产后6个月后仍高于妊娠前水平。 因此，描述怀孕-产后的体重和生物学变化，预测妇女在 不良心脏代谢特征的风险，并确定减轻这些特征的可改变因素， 创造有针对性的干预措施，以预防未来的慢性病的机会。为了增进我们对 妊娠-产后期间生物学变化的性质可能预测心脏代谢风险， 我们提出了一项从孕早期到产后3年的具有成本效益的纵向研究， 利用正在进行的妊娠队列的基础设施（R 01 HD 083369）。家长研究， 侧重于孕产妇产前生物学，因为它涉及到儿童健康的结果，目前正在招募一名 社会经济和种族多样性的样本290头三个月的孕妇。血液唾液 在母研究中收集整个妊娠期间的人体测量学和社会心理、生活方式和健康数据。 我们将利用现有的基础设施和收集的数据作为母公司研究的一部分，并将其扩展 现有的框架通过（1）评估来自库存的产前母体样品的额外的生物标志物， 在产后6个月、12个月和36个月获得新的母体生物样品;（2）检查母体如何 从孕早期到产后12个月的体重、免疫、内分泌和代谢生物标志物 预测母亲随后的心脏代谢风险，以及（3）识别可改变的孕产妇健康行为 可以减轻不利的心脏代谢健康结果。我们过度假设的前提是免疫者， 内分泌、代谢和体重的变化可能是长期的，并导致不良的妊娠结局。 心脏代谢特征，增加长期慢性疾病风险。其目的是：（1）确定产妇 妊娠-产后期间的体重曲线预测不良心脏代谢风险曲线 （2）描述怀孕期间的免疫、内分泌和代谢生物标志物特征- 产后期间，并确定其与心脏代谢风险的关联;（3）确定如何 可改变的健康行为与产后期间的体重和生物标志物变化相关， 预测心脏代谢风险。考虑到肥胖率的不断上升， 孕妇和需要有针对性的，生物和心理社会知情的治疗， 女性心脏代谢疾病。

Pregnancy marks a period of extreme physiological change as the maternal immune, endocrine, and metabolic systems rapidly adapt to sustain the growing fetus. It is conventionally assumed that these pregnancy-induced changes (e.g., elevated lipids, insulin resistance, weight gain) reverse by 6-months postpartum. Yet, evidence suggests that for some women physiological changes persist and may confer long-term risk of chronic diseases such as cardiovascular disease (CVD). We have demonstrated, for example, that inflammatory markers that confer risk for CVD may stay elevated above pre-pregnancy levels beyond 6-months postpartum. Thus, characterizing weight and biological changes across pregnancy-postpartum, predicting the women at risk for adverse cardiometabolic profiles, and identifying modifiable factors that mitigate these profiles offer opportunities to create targeted interventions to prevent future chronic disease. To improve our understanding of the nature of biological changes in the pregnancy-postpartum period that may predict cardiometabolic risk, we propose a cost-efficient longitudinal study extending from the first trimester through 3 years postpartum that capitalizes on the infrastructure of an ongoing pregnancy cohort (R01 HD083369). The parent study, which focuses on maternal prenatal biology as it relates to child health outcomes, is currently recruiting a socioeconomically and racially diverse sample of 290 first trimester pregnant women. Blood, saliva, anthropometry, and psychosocial, lifestyle, and health data are collected across pregnancy in the parent study. We will leverage the existing infrastructure and data collected as part of the parent study and expand that existing framework by (1) assessing additional biomarkers from banked prenatal maternal samples and obtaining new maternal biological samples at 6, 12, and 36 months postpartum; (2) examining how maternal weight, immune, endocrine, and metabolic biomarkers from the first trimester through 12 months postpartum predict subsequent cardiometabolic risk in the mother, and (3) identifying modifiable maternal health behaviors that may mitigate adverse cardiometabolic health outcomes. Our over-arching premise is that the immune, endocrine, metabolic, and weight changes of pregnancy can be long-lasting and contribute to an adverse cardiometabolic profile that increases long-term chronic disease risk. The aims are to: (1) identify maternal weight profiles in the pregnancy-postpartum period that predict adverse cardiometabolic risk profiles three years postpartum; (2) describe immune, endocrine, and metabolic biomarker profiles in the pregnancy- postpartum period, and determine their associations with cardiometabolic risk; and (3) determine how modifiable health behaviors are associated with weight and biomarker changes in the postpartum period and predict cardiometabolic risk. The significance of this project is high given the increasing rates of obesity in pregnant women and the need for targeted, biologically and psychosocially informed treatments to prevent cardiometabolic disease in women.