Pregnancy as a Window to Future Cardiovascular Health

描述（由申请人提供）：最近的流行病学研究表明，不良妊娠结局（APO），如先兆子痫的妇女，在随后的心血管疾病的风险增加。然而，缺乏前瞻性数据来阐明不良妊娠结局与随后的心血管疾病之间的确切关系。为了解决这一关键的知识差距，NHLBI发布了RFA，以研究怀孕作为未来孕产妇健康的窗口。在这份提案中，一个拥有不同人才的多学科团队 和专业知识将确定APO和心血管疾病风险标志物（CVDR）之间的关系在两年后交付。该多中心组将利用一个种族、种族、社会经济和地理上多样化的队列，其中有10，000名未经产妇女参加了NICHD资助的未经产妊娠结局研究：监测准妈妈（nuMoM 2b）。 拟议的研究是高度杠杆化的，利用了母研究中开发的广泛而独特的数据库和组织库，在母研究中，在妊娠过程中对未经产妇女进行评价，以研究APO的机制和预测。通过前瞻性数据收集、临床评价和超声评估以及通过使用标准化定义，入选nuMoM 2b队列的女性的表型非常好。人口统计学、心理社会学、饮食、生理和结果信息通过母亲访谈、自我管理的问卷、临床测量、超声和由受过培训的人员进行的病历提取来收集。采集孕妇血液、尿液和妊娠期宫颈阴道液以及分娩时脐带血和胎盘样本并储存。所有女性都完成了两份睡眠问卷，超过3,600人被招募在怀孕期间进行两次客观的夜间睡眠研究。 参与nuMoM 2b母研究的女性将在产后2至3年评估CVDR的证据，包括睡眠呼吸障碍（SDB）。还将评估后续妊娠中的APO。这些研究将描述载脂蛋白O与CVDR之间的关系，确定预示随后CVDR的首次妊娠特征，确定首次妊娠期间SDB与随后CVDR之间的关联，并确定介导首次和随后妊娠中CVDR与载脂蛋白O之间关联的可修改因素。这将有助于制定战略，以修改这些CVDR因素，并改善患有APO的妇女的健康。 相关性：NICHD目前正在进行一项大型研究，寻找测试来识别 第一次怀孕的妇女出现怀孕问题。在这项新的研究中，同样的妇女将在分娩后大约2年再次接受测试，看看那些有问题怀孕的妇女是否有心脏病的早期迹象。这项随访研究的信息将用于改善妇女在怀孕期间的健康状况。

DESCRIPTION (provided by applicant): Recent epidemiologic studies suggest that women with adverse pregnancy outcomes (APOs), such as preeclampsia, are at increased risk for subsequent cardiovascular diseases. However, prospective data to elucidate the precise relationship between adverse pregnancy outcomes and subsequent cardiovascular disease are lacking. To address this critical knowledge gap, the NHLBI issued a RFA to study pregnancy as a window to future maternal health. In this proposal, a multidisciplinary team with diverse talents and expertise will define the relationship between APOs and markers of cardiovascular disease risk (CVDR) at two years after delivery. This multicenter group will utilize an ethnically, raciall, socioeconomically and geographically diverse cohort of 10,000 nulliparous women enrolled in the NICHD-funded Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The proposed studies are highly leveraged, utilizing the extensive and unique database and tissue bank developed in the parent study in which nulliparous women are evaluated over the course of pregnancy to study the mechanisms for and prediction of APOs. Women enrolled in the nuMoM2b cohort are extremely well phenotyped through prospective data collection, clinical evaluations, and ultrasound assessments, as well as through the use of standardized definitions. Demographic, psychosocial, dietary, physiologic, and outcome information is collected through maternal interviews, self-administered questionnaires, clinical measurements, ultrasounds, and medical record abstraction by trained personnel. Samples of maternal blood, urine, and cervico-vaginal fluid over pregnancy and cord blood and placenta at delivery are collected and banked. All women complete two sleep questionnaires and over 3,600 are recruited to perform objective overnight sleep studies at two times during pregnancy. Women participating in the nuMoM2b parent study will be assessed for evidence of CVDR, including sleep disordered breathing (SDB), at two to three years postpartum. APOs in subsequent pregnancies also will be assessed. These studies will characterize the relationship between APOs and CVDR, identify first pregnancy profiles that portend subsequent CVDR, determine associations between SDB during the first pregnancy and subsequent CVDR, and identify modifiable factors that mediate the associations between CVDR and APOs in the first and subsequent pregnancy. This will allow for the development of strategies to modify these CVDR factors and to improve the health of women suffering APOs. Relevance: NICHD is currently conducting a large study that looks for tests to identify the risk of developing pregnancy problems in women who are pregnant for the first time. In this new study, the same women will be tested again at approximately 2 years after they give birth to see if there are early signs of heart disease in those who had problem pregnancies. Information from this follow-up study will be used to improve the health of women using their experiences during pregnancy.