Pregnancy complications in relation to stroke risk in African American women

项目摘要/摘要 在美国，非裔美国人中风的风险是白人的两倍。第三名领先者 女性的死因，中风对女性的影响比男性更大。妊娠引起的生理变化 在妊娠晚期和产后增加中风的风险。有一些证据表明， 主要来自北欧人群，高风险可能会在分娩后持续数年。这个 美国心脏协会(AHA)承认怀孕并发症是女性中风的危险因素， 但呼吁在AA女性中进行更多关于这一主题的研究--特别是在AA女性负担更重的情况下 几乎没有关于妊娠并发症和中风的研究 AA级的女人。我们建议在怀孕率高的人群中解决这一信息差距 并发症多，负担多，生活逆境多，中风风险高，在大的纵向 为此目的对再障女性进行的研究。黑人女性健康研究始于1995年，跟踪调查了59,000名AA 来自美国各地的女性，每两年收集一次数据。受访者报告了1,845起事件 自研究开始以来，中风和96,466例怀孕。我们建议开发一种研究资源 在再生障碍性贫血妇女中通过医疗记录和医疗记录验证自我报告的中风病例 医疗保险联动。我们建议评估妊娠并发症(早产、先兆子痫、 妊娠期糖尿病)单独或联合与AA女性发生中风的高风险相关 在以后的几年里。我们还将评估健康等因素对关联的可能修改 生活方式(例如，保持健康的孕后体重指数、健康饮食、不吸烟、身体健康 活动)或遭遇逆境(身体/性虐待、社会经济地位低、 种族主义和歧视)。我们将研究高血压、2型糖尿病和抑郁症作为潜在的 从妊娠并发症到中风的发展过程中的介体。拟议的研究将是 第一个解决一个关键的未知问题--怀孕并发症是否以及如何导致中风 AA妇女的发病率是妊娠并发症和中风的高危人群。这项研究 将促进我们对产后潜在缓解因素的理解，这些因素可能降低再障中风的风险 女人。从这项建议中获得的知识可以为患者、临床医生、研究人员和政策制定者提供信息， 并提高对妊娠并发症是再生障碍性贫血女性中风风险因素的认识。

PROJECT SUMMARY/ABSTRACT In the United States, African Americans (AAs) have a stroke risk twice that of Caucasians. The third-leading cause of death for women, stroke affects women more than men. Physiological changes due to pregnancy increase risk of stroke during the third trimester of pregnancy and postpartum. There is some evidence, primarily from Northern European populations, that the elevated risk may persist for years after delivery. The American Heart Association (AHA) recognizes pregnancy complications as risk factors for stroke in women, but called for more research among AA women on this topic—especially as AA women have a higher burden of pregnancy complications and there have been almost no studies on pregnancy complications and stroke in AA women. We propose to address this information gap in a population with a high prevalence of pregnancy complications, high burden of multiple life adversities, and a high risk of stroke, in the first large longitudinal study of AA women for this purpose. The Black Women's Health Study, begun in 1995, follows 59,000 AA women from across the U.S. and collects data every 2 years. Respondents have reported 1,845 incident strokes and 96,466 pregnancies since the study commenced. We propose to develop a resource for research on stroke in AA women by validating the self-reported stroke cases in the BWHS through medical records and Medicare linkage. We propose to assess whether pregnancy complications (preterm delivery, preeclampsia, gestational diabetes), individually and jointly, are associated with a higher risk of incident stroke in AA women in later years. We will also evaluate possible modification of the associations by factors such as healthy lifestyle (e.g., maintaining healthy post-pregnancy body mass index, healthy diet, non-smoking, physical activity) or by experiences of adversity (physical/sexual abuse, low socioeconomic status, experiences of racism and discrimination). We will investigate hypertension, type 2 diabetes, and depression as potential mediators that underlie the progression from pregnancy complications to stroke. The proposed study will be the first to address a critical unknown—whether and how pregnancy complications contribute to stroke incidence in AA women, a vulnerable population at high risk for pregnancy complications and stroke. The study will advance our understanding of potential mitigating factors postpartum that could lower risk of stroke for AA women. Knowledge gained from this proposal could inform patients, clinicians, researchers, and policy makers, and increase awareness' of pregnancy complications as stroke risk factors for AA women.