Preterm Delivery and Maternal Cardiovascular Disease Risk

描述(由研究人员提供)：早产与产妇心血管疾病风险摘要该应用程序的目标是确定：1)将早产与晚年产妇心血管疾病风险联系起来的机制；以及2)早产并可能受益于早期跟踪和干预以减少未来心血管疾病(CVD)的妇女亚群。在美国，12.5%的孕妇会发生早产，而且这一比例还在上升。与足月分娩的妇女相比，早产的妇女患心血管疾病的风险更高，但与这些情况有关的机制尚不清楚。PTD是一种异质性的结局，早产的妇女亚群可能会有不同的后遗症。我们假设，怀孕暴露了心血管疾病的易感性，炎症、血脂异常和血栓形成在怀孕期间汇聚，损害了早产妇女的胎盘和/或母体血管完整性。因此，患有PTD的妇女，特别是那些有胎盘血管病变的妇女，在产后会有致动脉粥样硬化的特征，并有动脉粥样硬化的早期证据。我们建议对参加妊娠结局和社区健康(POUCH)研究的妇女进行一项跟踪研究，该研究是1998-2004年间招募的前瞻性队列研究，旨在检查PTD的途径。在登记时采集血液样本，妊娠15-27周。提取产前、分娩和分娩记录，并由一名胎盘病理学家盲目检查胎盘。我们计划在这一框架的基础上，通过研究患有和不患有PTD的女性的心血管状况，并在参与邮袋研究后6-11年确定与心血管风险证据相关的PTD亚型。在邮袋研究期间，我们将招募大约896名女性(513名白人/其他人和383名非裔美国人)；217名早产妇女和679名足月分娩妇女。我们将收集问卷数据和测量动脉粥样硬化的概况，如人体测量学(身高、体重、腰围)、血压以及血液中炎症标记物、血脂和血栓形成因子的水平。此外，我们将通过颈动脉超声扫描(颈动脉内膜-中层厚度)评估动脉粥样硬化的早期证据。我们的目标将是在后续行动中比较结果指标。研究对象包括：1)有PTD病史的妇女；2)按临床情况和胎盘病理分类的PTD亚型；3)妊娠中期按血脂异常和炎症生物标志物水平分组的PTD亚型妇女。此外，我们将研究目标1中的关联是否可能被社会经济地位、种族或母亲抑郁/痛苦等因素所改变。发现PTD与母体心血管疾病风险之间联系的研究可以为这两个医疗问题带来新的干预策略，并有助于在疾病过程中非常早地识别干预可能延迟或预防疾病发生的女性。 与公共健康相关：最近的证据表明，早产的女性在晚年患心血管疾病的风险可能会增加，但人们对这种联系的性质知之甚少，仍然是一个黑匣子。在这项研究中，我们有一个独特的机会来评估一组妇女的动脉粥样硬化的形成情况和早期证据，作为早期早产研究的一部分，我们有详细的怀孕数据(生物标记物、胎盘病理学)。这项拟议的后续研究将有助于更深入地了解早产和后来的心血管疾病风险之间的联系，并将有助于针对心血管疾病高危妇女和选择适当的早期干预措施。

DESCRIPTION (provided by investigator): Preterm delivery and maternal cardiovascular disease risk Abstract The objective of this applications is to identify: 1) mechanisms that link preterm birth to later life maternal cardiovascular risk; and 2) subgroups of women who deliver preterm and might benefit from early tracking and interventions to reduce future cardiovascular disease (CVD). Preterm delivery (PTD) occurs in 12.5 percent of pregnancies in the U.S., and rates are increasing. Women who have delivered a preterm infant have excess risk of developing CVD compared to those with term deliveries, but mechanisms relating these conditions are not understood. PTD is a heterogenous outcome, and it is likely that subsets of women who deliver preterm may have different later life sequelae. We hypothesize that pregnancy unmasks a predisposition to CVD and that inflammation, dyslipidemia and thrombogenesis converge in pregnancy to compromise placentation and/or maternal vascular integrity among a subset of women who deliver preterm. Therefore women with PTD, particularly those with placental vascular lesions, will have an atherogenic profile post partum and early evidence of atherosclerosis. We propose a follow-up study of women enrolled in the Pregnancy Outcomes and Community Health (POUCH) Study, a prospective cohort enrolled from 1998-2004 designed to examine pathways to PTD. Blood samples were collected at enrollment, 15-27 weeks' gestation. Prenatal, labor and delivery records were abstracted and placentas were examined in a blinded fashion by a single placental pathologist. We plan to build on this framework by studying the cardiovascular profile among women with and without PTD and by identifying subtypes of PTD associated with evidence of cardiovascular risk at 6-11 years after POUCH Study participation. We will enroll approximately 896 women (513 white/other and 383 African Americans); 217 who delivered preterm and 679 who delivered at term during the POUCH Study. We will collect questionnaire data and measures of an atherogenic profile such as anthropometrics (height, weight, waist circumference), blood pressure, and blood levels of inflammatory markers, lipids, and thrombogenic factors. In addition we will assess early evidence of atherosclerosis via carotid ultrasound scans (carotid intimal- medial thickness). Our aims will be to compare the outcome measures at follow-up. i.e. atherogenic profile and early atherosclerosis among women with term births and: 1) women with a prior PTD; 2) women with PTD subtypes grouped by clinical circumstance and placental pathology; and 3) women with PTD subtypes grouped by levels of dyslipidemia and inflammation biomarkers in mid-pregnancy. In addition we will examine whether associations in Aim 1 might be modified by factors such as socioeconomic status, race, or maternal depression/distress. Studies that uncover pathways linking PTD to maternal CVD risk can lead to new intervention strategies for both of these medical problems, and help to identify women very early in the disease process when intervention may delay or prevent onset of disease. PUBLIC HEALTH RELEVANCE: Recent evidence indicates that women who deliver preterm may be at increased risk of CVD later in life, but the nature of this connection is poorly understood and remains a 'black box.' In this study we have a unique opportunity to assess the atherogenic profile and early evidence of atherosclerosis in a cohort of women for whom we have detailed pregnancy data (biomarkers, placental pathology) as part of an earlier study on preterm delivery. This proposed follow-up study will lead to a more in-depth understanding of the pathways that connect preterm delivery and later CVD risk, and will aid in targeting women at high risk for CVD and selecting appropriate early interventions.