Structural racism and cardiovascular disease risk in pregnant women and their infants

摘要 在美国，心血管疾病（CVD）是女性死亡的主要原因， 心脏代谢危险因素和心脏代谢相关妊娠并发症的患病率高于 黑人和代表性不足的妇女多于白色妇女。种族是一种社会结构，而不是生物结构，因此 族裔/种族本身不能解释妊娠期心脏代谢并发症的差异。这些 怀孕期间心脏代谢疾病的不平等现象可能部分是结构性种族主义造成的， 包括邻里环境和居住隔离。然而，关于结构性种族主义和CVD风险的研究 是有限的，特别是在怀孕和产后期间。因此，本建议的目的是 了解结构性种族主义是否与怀孕期间和产后的心血管疾病风险有关， 妇女和婴儿。该提案补充了血管老化研究的母婴决定因素 （MIDAS; R01HL157075）。MIDAS研究将招募840名不同种族/民族的健康和医学 妊娠34-40周的复杂母婴二对儿。妊娠34-40周时，48小时内 MIDAS研究将在分娩后6个月和12个月通过测量脉搏来评估CVD风险。 波速度（PWV），并检查生物，个人，社会和生态疾病风险之间的关系 PWV的因素。虽然邻居是父母补助金中提出的CVD风险因素，但这项建议 将通过增加结构性种族主义数据和对这些数据的深入分析来补充现有的MIDAS研究 和婴儿的心血管疾病风险。本研究的具体目标是：1）检查 妊娠晚期的结构性种族歧视和母体动脉僵硬度以及1年的变化轨迹 产后，和2）确定结构种族主义和婴儿动脉僵硬度之间的关联，在6 12个月，改为12个月。这种时间敏感的补充利用访问一个大的，多样化的 孕妇和产后妇女及其婴儿的队列，以及一个多学科的导师团队， 心血管疾病风险，孕产妇健康和种族健康差异的专业知识。因此，我们处于有利地位， 完成提出的目标。此外，该补充将使早期职业调查员能够：1）获得 进行明确的研究项目，评估孕妇的心血管疾病风险， 婴儿，2）发展她对妊娠相关心脏代谢生物标志物和宏观风险的知识 因素（邻里和社区一级），3）进一步的统计分析和统计技能，以及4） 扩大她的研究网络，并从一个成功的导师团队学习。这一补充将是一个不可分割的 通过关注孕产妇和婴儿面临的结构性种族主义相关风险， 心血管健康，它将为早期职业研究者提供支持，以促进她的职业生涯 并建立一个独立的，可资助的研究路线。

ABSTRACT In the United States, cardiovascular disease (CVD) is the leading cause of mortality in women, and the prevalence of cardiometabolic risk factors and cardiometabolic-related pregnancy complications are greater in Black and underrepresented women than White women. Race is a social construct and not biological, thus ethnicity/race alone cannot explain the disparities in cardiometabolic complications in pregnancy. These inequalities in cardiometabolic diseases during pregnancy may be explained in part by structural racism, which includes neighborhood environment and residential segregation. Yet, studies on structural racism and CVD risk are limited, particularly in pregnancy and the postpartum period. Therefore, the objective of this proposal is to understand whether structural racism is associated with CVD risk during pregnancy and postpartum among women and infants. This proposal supplements the Mother and Infant Determinants of vascular Aging Study (MIDAS; R01HL157075). The MIDAS study will enroll 840 racially/ethnically diverse healthy and medically complicated mother/infant dyads between 34-40 weeks’ gestation. At 34-40 weeks’ gestation, within 48 hours of delivery, and at 6 and 12 months postpartum, the MIDAS study will assess CVD risk by measuring pulse wave velocity (PWV), and examine relationships among biologic, personal, social, and ecological disease risk factors with PWV. Although neighborhood was a proposed CVD risk factor in the parent grant, this proposal will complement the existing MIDAS study by adding structural racism data and in-depth analysis of these data and CVD risk among women and infants. The study specific aims are to: 1) examine the association between structural racism and maternal arterial stiffness at the 3rd trimester in pregnancy and the trajectory to 1 year postpartum, and 2) determine the association between structural racism and infant arterial stiffness at 6 months and its change to 12 months. This time sensitive supplement leverages access to a large, diverse cohort of pregnant and postpartum women and their infants, and a multi-disciplinary team of mentors with expertise in CVD risk, maternal health, and racial health disparities. As a result, we are well positioned to complete the proposed aims. Additionally, this supplement will enable an early career investigator to: 1) gain experience conducting a well-defined research project evaluating CVD risk in pregnant women and their infants, 2) develop her knowledge on pregnancy-related cardiometabolic biomarkers and macro level risk factors (neighborhood and community-level), 3) further skills in statistical analysis and grantsmanship, and 4) expand her research network and learn from a successful mentorship team. This supplement will be an integral component to the MIDAS study by focusing on structural racism-related risk to maternal and infant cardiovascular health and it will provide an early career investigator with support to advance her career trajectory and establish an independent, fundable research line.