Accumulation of stress and trauma across the life course and cardiometabolic risk during pregnancy and postpartum

项目摘要 在美国，每10名孕妇中至少有1人患有心脏代谢紊乱。 每年怀孕，如妊娠高血压疾病(HDP；6-8%)或妊娠期 糖尿病(GDM；2-10%)。任何一种诊断都与产妇发病率的增加有关 和死亡率，不良的婴儿结局，以及心脏代谢性疾病的长期风险增加。 非西班牙裔黑人和低收入女性患心脏代谢性疾病的风险更高 在怀孕期间和之后与非西班牙裔白人或更高收入的妇女进行比较。仅限 这种差异的部分原因可以由医疗风险因素或获得护理的机会来解释。理论与实践 有限的证据表明，压力和创伤的经历，包括来自世界各地的种族主义 生命历程，增加不良妊娠结局和心脏代谢性疾病的风险 在以后的生活中。然而，证据是有限的，特别是在怀孕和产后。因此， 这项研究的首要目标是了解压力和创伤经历是如何 在整个生命过程中都体现在女性的心脏代谢健康中和之后 怀孕了。为了做到这一点，我将使用来自两个现有队列的数据，格雷迪创伤项目， 总部设在亚特兰大和CARDIA，并预期收集孕妇和产后的数据 设在亚特兰大的EmPOWR数据登记处的妇女。这个项目的具体目标是 目的：(1)评估终生创伤对心脏代谢紊乱的直接和间接影响 妊娠(HDP和GDM)。(2)估计危险的童年家庭环境对(A)的影响 妊娠期糖尿病事件(B)分娩后心脏代谢功能的变化。(3) (A)描述累积生活压力的轨迹和(B)估计不同生活压力的影响 孕前累积生活压力模式对产后体重减轻的影响。(4)估算 孕前累积生活压力对哺乳期及产后睡眠时间的影响 主要的培训经验将是培养测量和分析 女性心脏代谢性功能障碍的早期指标及其变化模型 在K99和R00阶段随时间变化的代谢生物标志物。研究和培训 将由Shakira Suglia博士领导的跨学科指导小组提供支持，并 由流行病学、产科和生命历程理论方面的专家组成。这些研究的结果 AIMS将扩大我们对女性心脏代谢健康轨迹及其 与整个生活过程中累积的压力的关系，并可能增加小说的选择 孕前、产前和产后的预防策略。

Project Abstract In the United States, at least 1 in 10 pregnant people experience a cardiometabolic disorder of pregnancy each year such as a hypertensive disorder of pregnancy (HDP; 6-8%) or gestational diabetes (GDM; 2-10%). Either diagnosis is associated with increased risk of maternal morbidity and mortality, poor infant outcomes, and long term increased risk of cardiometabolic disease. Non-Hispanic Black and low-income women face a higher risk of cardiometabolic disease during and following pregnancy compared to non-Hispanic white or higher income women. Only part of this difference can be explained by medical risk factors or access to care. Theory and limited evidence suggest that experiences of stress and trauma, including from racism across the life course, increase the risk of adverse pregnancy outcomes and cardiometabolic disease in later life. However, evidence is limited, particularly during pregnancy and postpartum. Thus, the overarching goal of this study is to understand how stressful and traumatic experiences across the life course are embodied in women’s cardiometabolic health during and following pregnancy. To do this, I will use data from two existing cohorts, the Grady Trauma Project, based in Atlanta, and CARDIA, and prospectively collect data from pregnant and postpartum women within the EmPOWR data registry, based in Atlanta. The specific aims of this project are to: (1) Estimate the direct and indirect effects of lifetime trauma on cardiometabolic disorders of pregnancy (HDP and GDM). (2) Estimate the effect of risky childhood family environment on (a) incident gestational diabetes (b) changes in cardiometabolic function following childbearing. (3) (a) Describe trajectories of cumulative life stress and (b) estimate the effect of distinct cumulative life stress patterns prior to pregnancy on postpartum weight loss. (4) Estimate the effect of cumulative life stress prior to pregnancy on lactation and sleep duration postpartum. The primary training experience will be to develop expertise in the measurement and analysis of early indicators of cardiometabolic dysfunction in women and the modeling of changes in metabolic biomarkers over time during both the K99 and R00 phases. The research and training will be supported by an interdisciplinary mentorship team led by Dr. Shakira Suglia and comprised of experts in epidemiology, obstetrics, and life course theory. The results from these aims will expand our understanding of women’s trajectories of cardiometabolic health and its relationship with cumulative stress across the life course and may expand options for novel prevention strategies in the preconception, prenatal, and postpartum periods.