Preconception and prenatal stress effects on cardiovascular disease risk in black women

项目摘要 心血管疾病（CVD）是死亡和发病的主要原因， 美国黑人女性令人信服的证据强调，怀孕是识别 未来CVD风险尽管黑人女性在怀孕期间患心血管并发症的风险也很高， 妊娠，异质性是了解和区分心血管疾病的风险表型之前，期间和 怀孕后缺乏。与种族压力模型一致，黑人妇女经常暴露在 背景紧张性刺激（例如，歧视、压力、逆境、暴力），这些因素导致种族歧视。 通过压力调节系统的改变来改善健康状况。产前应激反应与 产科保健差和不良的分娩结果，但对妇女的心血管疾病发病率的影响， 产后期不明确。针对RFA-MD-20-800“解决孕产妇中的种族差异” 死亡率和发病率“，拟议的研究探讨了产前压力调节的个体差异， 早期和慢性应激暴露影响产后CVD风险的生物学途径， 黑人女性这项研究还建立在越来越多的证据表明，膳食多不饱和脂肪酸 （PUFAs）与降低压力反应性和CVD风险有关，我们自己对黑人妇女的研究 支持其作为妊娠期间干预的可修改目标的效用。我们将探索 产前多不饱和脂肪酸水平对终生压力和产后心血管疾病风险之间的关系的保护作用。 匹兹堡女孩研究（PGS）是一项为期20年的纵向研究， 儿童期暴露，为阐明围产期CVD的表型提供了前所未有的机会 风险作为终身压力的函数。我们建议从PGS招募黑人孕妇（N = 400）， 收集CVD风险的生物行为测量（即，血脂、血糖、血压、肥胖、饮食、吸烟 和活动）和炎症标志物。这些新数据将与 关于孕前和产前CVD生物行为标志物、终生压力暴露的现有PGS数据， 产前压力调节，以解决黑人妇女的以下具体目标：（1）阐明围产期 与生活压力相关的心血管疾病风险表型;（2）检查产前压力调节对心血管疾病风险的影响。 探讨产前PUFAs对产后CVD风险的调节作用。拟议 纵向研究建立在多学科调查小组先前工作的基础上，将提供第一个 对黑人妇女围产期CVD风险表型的严格检查。实现既定目标 将告知风险的因果模型，并生成关键知识，以优化新目标的时机 采取干预措施，减少孕产妇心血管疾病发病率方面持续存在的种族差异。

PROJECT SUMMARY Cardiovascular disease (CVD) is a leading cause of mortality and morbidity and disproportionately affects Black American women. Compelling evidence highlights pregnancy as an important window for identifying future CVD risk. Although Black women are also at elevated risk for cardiovascular complications during pregnancy, heterogeneity is poorly understood and differentiated phenotypes of CVD risk before, during and after pregnancy are lacking. Consistent with models of racial stress, Black women are often exposed to contextual stressors (e.g., discrimination stress, adversity, violence) over the lifespan that contribute to racial disparities in health via alterations in stress regulation systems. Prenatal stress reactivity has been linked to poor obstetric health and adverse birth outcomes, but the effects of on women’s cardiovascular morbidity in the postpartum period are unclear. In response to RFA-MD-20-800 ‘Addressing Racial Disparities in Maternal Mortality and Morbidity’, the proposed research examines individual differences in prenatal stress regulation as a biological pathway through which early and chronic stress exposure impacts postpartum CVD risk among Black women. The study also builds on growing evidence shows that dietary polyunsaturated fatty acids (PUFAs) are associated with reduced stress reactivity and CVD risk, and our own work with Black women supports their utility as a modifiable target for intervention during pregnancy. Thus, we will explore the protective effects of prenatal PUFA levels on the association between lifetime stress and postpartum CVD risk. The Pittsburgh Girls Study (PGS), a 20-year longitudinal study that began annual assessments of stress exposures in childhood, provides an unprecedented opportunity to elucidate phenotypes of peripartum CVD risk as a function of lifetime stress. We propose to recruit Black pregnant women (N = 400) from the PGS and collect biobehavioral measures of CVD risk (i.e., lipids, blood sugar, blood pressure, adiposity, diet, smoking and activity) and inflammatory markers at 2, 12 and 24 months postpartum. These new data will be linked to extant PGS data on preconception and prenatal CVD biobehavioral markers, lifetime stress exposures, and prenatal stress regulation to address the following Specific Aims among Black women: (1) Elucidate peripartum phenotypes of CVD risk related to life stress; (2) Examine the impact of prenatal stress regulation on postpartum CVD risk; and (3) Explore the moderating effects of prenatal PUFAs on CVD risk. The proposed longitudinal study builds on the prior work of the multidisciplinary investigative team and will provide the first rigorous examination of peripartum phenotypes of CVD risk among Black women. Achieving the stated aims will inform causal models of risk and generate critical knowledge for optimizing the timing of, and novel targets for, interventions to reduce persistent racial disparities in maternal cardiovascular morbidity.