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

怀孕标志着母体免疫、内分泌和新陈代谢发生极端生理变化的时期 系统迅速适应，以支持不断增长的胎儿。传统上认为这些由怀孕引起的 这些变化(例如，血脂升高、胰岛素抵抗、体重增加)在产后6个月内逆转。然而，有证据表明 这表明，对一些女性来说，生理变化持续存在，并可能带来慢性疾病的长期风险 心血管疾病(CVD)等疾病。例如，我们已经证明，煽动性 在产后6个月后，心血管疾病风险的标志物可能会保持在高于孕前水平的水平。 因此，表征怀孕-产后的体重和生物变化，预测妇女在 不良心脏代谢特征的风险，并确定缓解这些特征的可修改因素 有机会制定有针对性的干预措施，以预防未来的慢性病。提高我们的认识 怀孕-产后期生物变化的性质可以预测心脏代谢风险， 我们建议进行一项从妊娠早期到产后3年的成本效益纵向研究 利用正在进行的怀孕队列的基础设施(R01 HD083369)。家长研究，这是 专注于与儿童健康结局有关的孕产妇产前生物学，目前正在招聘一名 290名早期妊娠妇女的社会经济和种族多样性样本。血，唾液， 在父母研究中收集了怀孕期间的人体测量学、心理社会、生活方式和健康数据。 我们将利用作为母公司研究的一部分收集的现有基础设施和数据，并对其进行扩展 现有框架：(1)从储存的产前孕产妇样本中评估额外的生物标记物 在产后6个月、12个月和36个月获得新的产妇生物样本；(2)检查产妇 从妊娠早期到产后12个月的体重、免疫、内分泌和代谢生物标记物 预测母亲随后的心脏代谢风险，以及(3)确定可改变的母亲健康行为 这可能会减轻不利的心脏代谢健康后果。我们最重要的前提是免疫， 妊娠的内分泌、新陈代谢和体重变化可能是长期的，并导致不利的 增加长期慢性病风险的心脏代谢特征。其目的是：(1)识别母亲 妊娠-产后体重曲线预测不良心脏代谢风险曲线3 (2)描述怀孕期间的免疫、内分泌和代谢生物标记物-- 产后期，并确定它们与心脏代谢风险的关系；以及(3)确定如何 可改变的健康行为与产后体重和生物标记物的变化有关 预测心脏代谢风险。鉴于年肥胖率不断上升，这个项目的意义很大。 孕妇和需要有针对性的、生物和心理知情的治疗以预防 女性的心脏代谢性疾病。

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.