Reducing Cardiovascular Risk in Women with Hypertension or Diabetes in Pregnancy

降低妊娠期高血压或糖尿病女性的心血管风险

• 批准号: 7771991
• 负责人: Wendy Lynet Bennett
• 金额: $ 13.93万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-20 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7771991
• 关键词: Address; Affect; Behavior; Behavior Therapy; Behavioral; Blood Vessels; Cardiovascular Diseases; Caring; Cause of Death; Chronic Disease; Clinical Research; Clinical Trials Design; Cohort Studies; Conduct Clinical Trials; Data; Data Analyses; Development; Development Plans; Diagnosis; Discipline of obstetrics; Disease; Effectiveness of Interventions; Epidemiology; Fellowship; Future; Gestational Diabetes; Glucose Intolerance; Goals; Grant; Health Insurance; Health Surveys; Health behavior; Health behavior change; Healthcare; Heart Diseases; High Prevalence; High Risk Woman; Hypertension; Inflammatory; Insurance; Internal Medicine; Intervention; Lead; Life; Life Style; Long-Term Effects; Medicaid; Medical; Medical Surveillance; Medicine; Mentors; Metabolic; Metabolic syndrome; Minority Groups; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Pattern; Physiological; Population; Postpartum Period; Predisposition; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Preventive; Primary Health Care; Primary Prevention; Principal Investigator; Recommendation; Recruitment Activity; Reinforcing Factor; Research; Research Personnel; Resources; Risk; Risk Factors; Sampling; Science; Stress Tests; Training; United States; Universities; Visit; Woman; abstracting; cardiovascular disorder risk; cardiovascular risk factor; career; career development; clinical research site; design; effective intervention; experience; follow-up; health care service utilization; heart disease risk; high risk; improved; medical schools; men; mortality; professor; programs; prospective; public health relevance; skills

DESCRIPTION (provided by applicant): Women with recent pregnancy complications, such as gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy (HDP), have an increased risk of developing cardiovascular disease (CVD). Pregnancy provides a unique opportunity to identify women with these vascular risk factors earlier in life. Yet, we are missing this window of opportunity, as women are often lost to follow- up postpartum and do not received recommended care. There is a paucity of evidence on how to effectively promote and sustain CVD-preventive health behaviors in this high risk population. The overall objective of the proposed study is to identify barriers to and predictors of CVD-preventive health behaviors, including medical follow-up and healthy lifestyle behaviors, in the postpartum period in women with recent GDM and HDP. Using the PRECEDE-PROCEED model, we will use these findings to develop an interventional study to address the predisposing, enabling and reinforcing factors that influence CVD-preventive health behaviors. Results from this proposal could have broad implications for the development of practical and sustainable strategies to decrease CVD morbidity and mortality in women. The specific aims are to: 1) conduct a retrospective cohort study to describe healthcare utilization patterns and predictors of follow-up medical care in the first year postpartum in women with GDM and/or HDP; 2) conduct a prospective cohort study to determine predictors CVD-preventive behaviors in the first year postpartum in women with GDM and/or HDP; 3) design and carry-out a pilot multilevel educational-behavioral intervention to increase CVD-preventive health behaviors in women with GDM and/or HDP. The candidate is completing a clinical research fellowship in General Internal Medicine (GIM) at Johns Hopkins University School of Medicine and will take an Assistant Professor post at Johns Hopkins in July, 2009. Her primary mentor is Dr. Jeanne Clark, Associate Professor of Medicine and Epidemiology, with extensive experience in mentoring, epidemiology, and the design of clinical trials. Her co-mentor is Dr. David Levine, Professor of Medicine, principal investigator of the NHLBI training grant on behavioral aspects of CVD and an established investigator and mentor. The candidate's long term career goal is to establish an independent research program in the primary prevention of CVD in women. To accomplish this goal, her short term goals involve a career development plan to enhance her skills in longitudinal data analysis, health survey research, health behavior science, and the design and conduct of clinical trials. Results of this proposal will lead to the development of a pilot intervention in years 4 and 5 and an R01 proposal early in year 5 to investigate the effectiveness of an intervention to improve CVD-preventive health behaviors in the postpartum period in women with recent GDM and/or HDP. PUBLIC HEALTH RELEVANCE: Women with recent high blood pressure or diabetes in pregnancy have an increased risk of developing heart disease later in life. However, many women are lost to follow-up after delivery and do not receive recommendations promoting continued medical surveillance and healthy lifestyle changes to reduce their heart disease risk. The purpose of this study is to identify barriers for women to receive medical follow-up care and engage in healthy lifestyle behaviors in the postpartum period, in order to design effective strategies to decrease their risk of heart disease. (End of Abstract)

描述(申请人提供)：最近有妊娠并发症的妇女，如妊娠期糖尿病(GDM)和妊娠期高血压疾病(HDP)，患心血管疾病(CVD)的风险增加。怀孕提供了一个独特的机会，可以在生命早期识别出患有这些血管危险因素的女性。然而，我们正在错过这个机会之窗，因为妇女经常失去产后随访，没有得到推荐的护理。关于如何在这一高危人群中有效地促进和维持预防心血管疾病的健康行为，缺乏证据。这项拟议研究的总体目标是确定最近患有妊娠期糖尿病和HDP的妇女产后期间心血管疾病预防健康行为的障碍和预测因素，包括医疗随访和健康生活方式行为。利用先行模型，我们将利用这些发现开展一项干预性研究，以解决影响心血管疾病预防健康行为的易感、使能和强化因素。这一提议的结果可能对制定切实和可持续的战略以减少妇女心血管疾病发病率和死亡率产生广泛影响。其具体目的是：1)开展一项回顾性队列研究，描述妊娠期糖尿病和/或HDP妇女产后第一年的卫生保健利用模式和随访医疗保健的预测因素；2)开展前瞻性队列研究，以确定GDM和/或HDP妇女产后第一年心血管疾病预防行为的预测因素；3)设计和开展试点的多层次教育-行为干预措施，以增加GDM和/或HDP妇女的心血管疾病预防健康行为。这位候选人即将完成约翰霍普金斯大学医学院普通内科(GIM)的临床研究奖学金，并将于2009年7月在约翰霍普金斯大学担任助理教授一职。她的主要导师是珍妮·克拉克博士，医学和流行病学副教授，在指导、流行病学和临床试验设计方面拥有丰富的经验。她的共同导师是大卫·莱文博士，他是医学教授，NHLBI心血管疾病行为方面培训拨款的首席研究员，也是一名成熟的研究员和导师。候选人的长期职业目标是在女性心血管疾病一级预防方面建立一个独立的研究计划。为了实现这一目标，她的短期目标包括一个职业发展计划，以提高她在纵向数据分析、健康调查研究、健康行为科学以及临床试验设计和实施方面的技能。这一建议的结果将导致在第4年和第5年制定一项试点干预措施，并在第5年早些时候制定一项R01建议，以调查一项干预措施的有效性，以改善最近患有妊娠期糖尿病和/或HDP的妇女产后预防心血管疾病的健康行为。 公共卫生相关性： 最近怀孕期间患有高血压或糖尿病的妇女在以后的生活中患心脏病的风险增加。然而，许多妇女在分娩后失去了跟踪，并且没有收到促进持续医疗监测和健康生活方式改变的建议，以降低她们患心脏病的风险。本研究的目的是找出产后妇女在接受医疗随访护理和从事健康生活方式方面的障碍，以设计有效的策略来降低她们患心脏病的风险。(摘要结束)