Gestational diabetes mellitus, gestational hypertension and risk of metabolic syndrome

摘要 提案摘要-本提案概述了5年培训和研究计划， 研究员，以实现他的目标，成为一个独立的学术病人为导向的研究人员。的 候选人将利用他在孕产妇健康和妇女保健方面的强大学术背景、培训和专业知识， 改善有妊娠糖尿病史妇女的护理、筛查、结局和随访 代谢综合征是妊娠期高血压疾病的直接预测因子， 心血管疾病作为一名硕士生，候选人设计并进行了成功的临床试验 男性伴侣和夫妇在怀孕期间进行艾滋病毒检测。他也是一个福格蒂学者，研究员， 在此期间，他担任研究协调员，负责招募和随访参与者2年。的 拟议的计划将建立在候选人的丰富经验与临床研究的资源 通过提高他在研究设计和纵向数据的流行病学分析方面的技能， 提高他对代谢综合征，心血管疾病流行病学的理解，以及 炎症标志物在疾病过程中。候选人是由优秀的专家导师在一个 优秀的制度环境和大学之间非常成功的合作伙伴关系 内罗毕和华盛顿大学。心血管疾病（CVD）在亚 撒哈拉非洲是一个日益沉重的负担，主要影响到年轻人和妇女。高血压 妊娠期糖尿病（GDM）和妊娠期糖尿病（HDP）会增加未来CVD的风险 比两倍。HDP、GDM和CVD是代谢综合征（MetS）的特征，代谢综合征是一组因素， 直接增加CVD的风险，表明共同的病理，这可以作为筛查的目标， 监测和干预。与高收入国家有监测妇女的指导方针相比， 在HDP和GDM之后，LMIC中的妇女无法获得这些服务或CVD预防， 目前已确诊CVD。与世界其他地区相比，撒哈拉以南非洲地区的心血管疾病 不同的炎症和动脉粥样硬化的病因和妇女在撒哈拉以南非洲地区，因此， 具有影响HDP与GDM、MetS与CVD之间关联的独特差异。我们建议 进行一项前瞻性队列研究，以估计肯尼亚代谢综合征的负担和特征， 遵循HDP和GDM，使用以下具体目标。目标1：证明患有艾滋病的妇女与 没有HDP和GDM的孕妇在分娩后24周更有可能患有MetS。目标2：在没有 在分娩后24周的MetS，确定HDP和GDM是否与HDP和GDM的诊断增加相关。 3年随访期间的MetS。目标3：确定下列妇女的社会人口学和生物学相关因素： 在24至36个月后的不同时间点，与未诊断MetS的患者相比， 这可能导致改善筛查和随访的妇女与HDP和GDM。我们的研究结果 将告知撒哈拉以南非洲孕产妇保健诊所的高出勤率，在那里，每10人中至少有1人 妇女被诊断为妊娠期高血压疾病和妊娠期糖尿病， 分娩后战略的机会，以确定妇女与MetS及时心血管疾病预防干预。 这些发现可能会为产妇保健和初级保健的联系提供信息，并为筛查和 在资源有限的情况下，监测患有艾滋病、性别歧视和代谢综合征的妇女的战略。

Abstract Summary of Proposal – This proposal outlines 5-year training and research program that will allow the investigator to achieve his goal of becoming an independent academic patient-oriented researcher. The Candidate will use his strong academic background, training and expertise in maternal health and women’s health to improve on care, screening, outcomes and follow-up of women with history of gestational diabetes and hypertensive disease in pregnancy by focusing on metabolic syndrome, a direct predictor of cardiovascular disease. As a masters student the candidate designed and conducted a successful clinical trial on male partner and couple HIV testing during pregnancy. He has also been a Fogarty scholar, and Fellow during which he served as a study coordinator in enrolling and following up participants for 2 years. The proposed program will build on the candidate’s extensive experience with clinical research in resource constrained settings by improving his skills in study design and epidemiologic analysis of longitudinal data and enhancing his understanding of metabolic syndrome, cardiovascular disease epidemiology, and the role of inflammatory markers in the disease process. The Candidate is a supported by excellent expert mentors in an outstanding institutional environment and a highly successful collaborative partnership between the University of Nairobi and the University of Washington. RESEARCH PLAN –Cardiovascular disease (CVD) in sub- Saharan Africa is a growing burden, and predominantly affects younger people and women. Hypertensive disease in pregnancy (HDP) and gestational diabetes mellitus (GDM) increase the risk of future CVD more than two-fold. HDP, GDM and CVD are characterized metabolic syndrome (MetS), a cluster of factors that directly increase the risk of CVD suggesting a shared pathology, which can be targeted for screening, monitoring and intervention. In contrast to high-income countries that have guidelines on monitoring women after HDP and GDM, women in LMIC do not have access to these services or CVD prevention and instead present with established CVD. Compared to the rest of the world, CVD in sub-Saharan Africa is distinctively different in its inflammatory and not atherosclerotic etiology and women in sub-Saharan Africa may therefore have unique differences that influence the association between HDP and GDM, MetS and CVD. We propose to conduct a prospective cohort study to estimate the burden and characteristics of metabolic syndrome in Kenya, following HDP, and GDM using the following specific aims. Aim 1: Demonstrate that women with versus those without HDP and GDM are more likely to have MetS at 24 weeks post delivery. Aim 2: Among women without MetS at 24 weeks post-delivery, determine whether HDP and GDM is associated with increased diagnosis of MetS during 3 years of follow-up. Aim 3: Determine sociodemographic and biological correlates of women who are diagnosed with MetS compared to those without MetS at different time points from 24 to 36 months post delivery that may lead to improved screening and follow-up of women with HDP and GDM. Our study findings will inform use of high attendance of maternal health clinics in sub-Saharan Africa, where at least 1 in 10 women are diagnosed with hypertensive disease of pregnancy and gestational diabetes mellitus, as a window of opportunity for post delivery strategies to identify women with MetS for timely CVD prevention interventions. These findings may inform maternal health and primary care linkages, and development of screening and monitoring strategies of women with HDP, GDM, and MetS in resource-constrained settings.