Reducing Cardiovascular Risk in Women with Hypertension or Diabetes in Pregnancy

描述（由申请人提供）：近期妊娠并发症，如妊娠期糖尿病（GDM）和妊娠期高血压疾病（HDP）的女性，发生心血管疾病（CVD）的风险增加。怀孕提供了一个独特的机会，以确定妇女与这些血管危险因素在生命的早期。然而，我们正在错过这一机会之窗，因为妇女往往在产后失访，没有得到推荐的护理。关于如何在高危人群中有效促进和维持心血管疾病预防健康行为的证据很少。拟议研究的总体目标是确定近期GDM和HDP女性产后期间CVD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。使用PRECEDE-PROCEED模型，我们将利用这些发现来开发一项干预性研究，以解决影响心血管疾病预防健康行为的诱发因素、促成因素和强化因素。这一建议的结果可能对制定切实可行的可持续战略以降低女性心血管疾病发病率和死亡率产生广泛影响。具体目标是：1）进行回顾性队列研究，以描述GDM和/或HDP妇女产后第一年的医疗保健利用模式和后续医疗保健的预测因素; 2）进行前瞻性队列研究，以确定GDM和/或HDP妇女产后第一年CVD预防行为的预测因素; 3）设计并实施多层次教育行为干预试点，提高GDM和/或HDP妇女预防心血管疾病的健康行为。候选人正在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月在约翰霍普金斯担任助理教授。她的主要导师是医学和流行病学副教授Jeanne Clark博士，在指导，流行病学和临床试验设计方面拥有丰富的经验。她的共同导师是医学教授大卫莱文博士，NHLBI关于CVD行为方面的培训补助金的主要研究者，也是一位既定的研究者和导师。候选人的长期职业目标是建立一个独立的研究计划，在一级预防心血管疾病的妇女。为了实现这一目标，她的短期目标包括职业发展计划，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的设计和实施方面的技能。该提案的结果将导致在第4年和第5年制定试点干预措施，并在第5年初制定R 01提案，以调查干预措施对改善近期GDM和/或HDP女性产后期心血管疾病预防健康行为的有效性。 公共卫生相关性： 近期患有高血压或糖尿病的孕妇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后续行动，并且没有收到促进持续医疗监测和健康生活方式改变以降低心脏病风险的建议。本研究的目的是确定妇女在产后期间接受医疗后续护理和从事健康生活方式行为的障碍，以便设计有效的策略来降低其患心脏病的风险。(End摘要）

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)