Pregnancy as a Window to Future Cardiovascular Health: Adverse Pregnancy Outcomes Supplement Request

最近的流行病学研究表明，有不良妊娠结局（APO）的妇女，如 先兆子痫的孕妇患后续心血管疾病的风险增加。然而，前瞻性数据 阐明不良妊娠结局与随后的心血管疾病之间的确切关系 疾病缺乏。为了解决这一关键的知识差距，NHLBI发布了一项研究妊娠的RFA， 一扇通向未来产妇健康的窗户在这份提案中，一个拥有不同人才的多学科团队， 专业知识将定义载脂蛋白和心血管疾病风险标志物（CVDR）之间的关系， 分娩后两年。这个多中心小组将利用一个种族，种族，社会经济和 地理上不同的10 000名未经产妇女队列参加了由国家儿童和社会发展中心资助的 妊娠结局研究：监测准妈妈（nuMoM 2b）。 拟议的研究是高度利用，利用广泛和独特的数据库和组织库 在母体研究中开发，在母体研究中，对未经产的妇女在妊娠过程中进行评价， 研究APO的机制和预测。在nuMoM 2b队列中登记的妇女非常 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。人口统计学、心理社会学、饮食、生理学和 结果信息是通过母亲访谈，自我管理的问卷调查，临床 测量、超声波和医疗记录提取。产妇样本 收集妊娠期的血液、尿液和宫颈阴道液，以及分娩时的脐带血和胎盘 和银行。所有女性都完成了两份睡眠问卷，超过3,600人被招募来进行客观的调查。 在怀孕期间进行两次夜间睡眠研究。 将评估参与nuMoM 2b母研究的女性的CVDR证据，包括 产后两到三年出现睡眠呼吸障碍（SDB）。在随后的怀孕中， 将被评估。这些研究将描述APO与CVDR之间的关系，首先确定 预示随后CVDR的妊娠特征，确定第一次妊娠期间SDB之间的关联 妊娠和随后的CVDR，并确定介导 CVDR和APO在第一次和随后的怀孕。这将有助于制定战略， 修改这些CVDR因素，并改善患有APO的妇女的健康。 相关性（参见说明）： NICHD目前正在进行一项大型研究，寻找测试来确定怀孕的风险 第一次怀孕的妇女的问题。在这项新的研究中， 在他们分娩后大约2年再次检查，看看这些婴儿是否有心脏病的早期迹象。 有问题的孕妇这项随访研究的信息将用于改善 女性在怀孕期间的经验。

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, racially, 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 (See instructions): 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.