Arterial stiffness in mother/infant dyads: Life course approach to prevent cardiovascular disease

摘要 心血管疾病(CVD)是美国女性的主要死因，每年导致40万女性死亡。 与白人相比，非西班牙裔黑人和拉丁裔女性患心血管疾病的风险更高。尽管有心血管疾病的负担 在女性中，对女性特有的风险因素研究不足，因此没有考虑到当前的心血管疾病风险。 预测或预防战略。及早发现亚临床疾病是心血管疾病风险分层和 预防。由于产前和产后护理是大多数美国女性唯一的医疗保健接入点， 怀孕是衡量心血管疾病风险和实施创新战略的关键机会 解决妇女保健方面的这一严重差距。此外，心血管疾病危险因素的轨迹始于宫内和宫内 早产儿，因此怀孕也是确定儿童心血管疾病风险的机会。我们的长期目标是 确定和传播可降低妇女及其子女心血管疾病风险的产科护理做法。这个 这项前瞻性多中心研究的目的是评估健康和复杂医学疾病患者的心血管风险。 孕妇和她们的婴儿。我们还将研究个人、社会和社会之间的关系 产后3年生态因素与心血管疾病危险性的关系。我们的主要结果是母婴 中心脉搏波速度(PWV)，一种有效的动脉僵硬(血管老化)指标，可预测心血管疾病， 独立于其他已确定的心血管疾病风险因素。我们将招募840名不同性别的孕妇 种族/民族和社会经济地位：420名健康妇女和420名患有先兆子痫、妊娠期糖尿病、 和/或疑似胎儿生长受限。我们将测量母婴PWV、心脏代谢(例如， 血压、血脂、肥胖、糖化血红蛋白)和炎症(如hs-CRP、IL-6、脂联素)是心血管疾病的标志物 在怀孕34-40周、分娩、6个月、18周时评估个人、社会和生态因素 几个月，三年。本研究的目的如下：1)用脉搏波传导速度测量动脉硬度。 怀孕；2)在健康和复杂的怀孕后测量婴儿/儿童PWV；和3) 确定与PWV测量的心血管疾病风险相关的母婴可修改风险因素。到目前为止，没有 有研究纵向测量了孕妇及其婴儿患心血管疾病的风险，但并未确定其影响。 生物、个人、社会和/或生态因素对心血管疾病风险的影响。使用一种非侵入性测量动脉 僵硬，我们建议确定一组母婴二元组的心血管疾病风险。我们的跨学科研究 心血管疾病、高危妊娠、运动和运动生理学、心血管疾病流行病学、公众 健康和心脏病学已经做好准备，通过综合利用专业知识来实现拟议的目标 实现我们共同的、共同的目标，即降低妇女及其子女的心血管疾病风险。我们正在提议一项 产前保健目标的创新范式转变，将怀孕作为妇女生命中的一段时间，特别是 如果她有心血管疾病的高风险，为她自己和她的后代识别和减轻心血管疾病的早期标志。

ABSTRACT Cardiovascular disease (CVD) is the leading cause of death for U.S women, annually killing >400,000 women. Compared to whites, non-Hispanic Black and Latina women are at higher CVD risk. Despite the burden of CVD in women, risk factors specific to women are understudied and thus not considered in current CVD risk prediction or prevention strategies. Early detection of subclinical disease is key to CVD risk stratification and prevention. Since prenatal and postpartum care is the sole health care access point for most U.S. women, pregnancy represents a critical opportunity to measure CVD risk and implement innovative strategies to address this critical gap in women’s health care. Furthermore, CVD risk factor trajectories begin in utero and in early life, so pregnancy is also an opportunity to identify CVD risk in children. Our long-range goal is to identify and disseminate obstetric care practices that mitigate CVD risk for women and their children. The objective of this prospective, multicenter study is to estimate CVD risk in healthy and medically complicated pregnant women and their infants. We will also examine the relationships among personal, social, and ecological factors and CVD risk for 3 years postpartum. Our primary outcomes are maternal and infant central pulse wave velocity (PWV), a validated measure of arterial stiffness (vascular aging) that predicts CVD, independent of other established CVD risk factors. We will enroll a cohort 840 pregnant women of diverse race/ethnicity and socioeconomic status: 420 healthy and 420 women with preeclampsia, gestational diabetes, and/or suspected fetal growth restriction. We will measure maternal and infant PWV, cardio-metabolic (e.g., blood pressure, lipids, adiposity, HbA1c) and inflammatory (e.g., hs-CRP, IL-6, adiponectin) markers of CVD risk, and assess personal, social, and ecological factors at 34-40 weeks’ gestation, delivery, 6 months, 18 months, and 3 years. The study aims are the following: 1) Measure arterial stiffness by PWV during and after pregnancy; 2) Measure infant/child PWV following healthy and complicated pregnancies; and 3) Identify maternal and infant modifiable risk factors associated with CVD risk measured by PWV. To date, no studies have longitudinally measured CVD risk in pregnant women and their infants, nor ascertained the effect of biologic, personal, social, and/or ecological factors on CVD risk. Using a noninvasive measure of arterial stiffness, we propose to determine CVD risk in a cohort of mother-infant dyads. Our interdisciplinary study team of experts in CVD, high-risk pregnancy, exercise and sports physiology, CVD epidemiology, public health, and cardiology are well poised to complete the proposed aims by using a synthesis of expertise to achieve our common, shared goal of mitigate CVD risk for women and their children. We are proposing an innovative paradigm shift in the goals of prenatal care to use pregnancy as a time in a woman’s life, particularly if she is at high risk for CVD, to identify and mitigate early markers of CVD for herself and her offspring.