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个孕妇中至少有1个患有心脏代谢紊乱， 妊娠期高血压疾病（HDP; 6 - 8%）或妊娠期高血压疾病（HDP; 6 - 8%） 糖尿病（GDM; 2 - 10%）。任何一种诊断都与孕产妇发病风险增加有关 和死亡率，婴儿预后不良，以及心脏代谢疾病的长期风险增加。 非西班牙裔黑人和低收入妇女面临更高的心脏代谢疾病风险 与非西班牙裔白色或高收入妇女相比，只 这种差异的部分原因是医疗风险因素或获得护理的机会。理论和 有限的证据表明，压力和创伤的经历，包括来自种族主义的经历， 增加不良妊娠结局和心脏代谢疾病的风险 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，在本发明中， 这项研究的首要目标是了解压力和创伤性经历 体现在妇女的心脏代谢健康期间和之后 怀孕为此，我将使用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，并前瞻性地收集数据，从怀孕和产后 在亚特兰大的EmPOWR数据登记处的女性。该项目的具体目标是 目的：（1）估计终身创伤对心脏代谢疾病的直接和间接影响， 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（B）在分娩后心脏代谢功能改变。（三） (a)描述累积生活压力的轨迹，并（B）估计不同 怀孕前的累积生活压力模式对产后体重减轻的影响。(4)估计 孕前累积生活压力对哺乳和产后睡眠时间影响 主要的培训经验将是发展测量和分析的专门知识， 女性心脏代谢功能障碍的早期指标和 在K99和R00阶段期间，代谢生物标志物随时间的变化。研究和培训 将得到由Shakira Suglia博士领导的跨学科导师团队的支持， 由流行病学、产科和生命历程理论专家组成。结果从这些 目标将扩大我们对女性心脏代谢健康轨迹及其 与整个生命过程中的累积压力的关系，并可能扩大新的选择 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.