Hypertensive Disorders of Pregnancy and Early Risk of Maternal CVD: Influence of the External Exposome

项目总结 妊娠高血压疾病(HDP)是最常见的妊娠并发症，与 心血管疾病(CVD)的长期风险增加，这也是 美国的女性。新出现的证据表明，怀孕期间的环境暴露可能会对 在HDP的发展中发挥着重要作用。然而，存在几个限制，包括1)对 暴露评估中怀孕期间的居住流动性，2)缺乏研究考虑不同的 HDP的亚型、发病和严重程度，以及3)缺乏对整个环境的考虑(即 曝光)。虽然HDP与怀孕后的长期心血管疾病风险有关，但有关HDP的数据有限 合并HDP的早期母体心血管疾病风险(分娩后头五年内)。更重要的是，不 研究的重点是孕期和孕期后环境暴露对母亲心血管疾病风险的影响。 怀孕后。此外，HDP的风险评估模型主要依赖于不是 在所有孕妇中普遍进行了测试，但还没有开发出预测模型来识别 怀孕后患心血管疾病风险较高的妇女。这项研究建立在我们之前在外部曝光组和 利用我们对全州范围内唯一链接的电子健康记录-出生记录数据的访问 One佛罗里达临床研究联盟通过以下方式应对该领域的多重挑战：1)确定 妊娠外暴露与HDP风险的相关性，考虑到亚型、发病和 HDP的严重程度和在暴露测量中考虑怀孕居住流动性；2)评估 妊娠后母亲心血管疾病的早期风险与HDP和外部暴露有关，以及3) HDP和孕后母体心血管疾病早期风险的预测模型的建立。这项研究项目将 参加全面的培训计划，包括课程、指导经验和临床 由一个成熟的专家团队进行学习、研讨会和指导。该培训计划旨在 进一步发挥我的长处，发展新的研究技能，同时为我们对 环境对孕妇和产后妇女心血管健康的影响。培训 提案详细说明了心血管健康、组学和非正式指导的五年计划 展示研究、生物医学信息学和数据科学，以及专业技能。我的短期职业生涯 目标包括完成所有培训领域的课程作业，通过出版物传播研究结果 和演讲，从事职业发展活动，并申请独立的R01资金 该奖项的第三个年头。我的长期职业目标是成为一名独立、协作、高效的 流行病学家和健康数据科学家领导心血管健康研究项目，重点是其 使用大数据与围产期和环境流行病学交叉。

PROJECT SUMMARY Hypertensive disorders of pregnancy (HDP) are the most common pregnancy complication and are associated with an increased long-term risk of cardiovascular disease (CVD) which is also the leading cause of death for women in the US. Emerging evidence suggests that environmental exposure during pregnancy may play an important role in the development of HDP. However, several limitations exist, including 1) the ignorance of residential mobility during pregnancy in exposure assessments, 2) the lack of studies considering different subtype, onset, and severity of HDP, and 3) the lack of considerations of the totality of environment (i.e. the exposome). While HDP have been linked to long-term CVD risk after pregnancy, limited data are available on early maternal CVD risk (within the first five years after delivery) complicated by HDP. More importantly, no study has focused on the impact of environmental exposures during and after pregnancy on maternal CVD risk after pregnancy. In addition, risk assessment models of HDP predominantly rely on biomarkers that are not ubiquitously tested among all pregnant women, and no predictive model has been developed to identify women at higher CVD risk after pregnancy. This study builds on our prior work in the external exposome and leverages our access to the unique statewide linked electronic health records-birth records data from the OneFlorida Clinical Research Consortium to address multiple challenges in the field by: 1) determining the association between pregnancy external exposome and risk of HDP, considering the subtype, onset, and severity of HDP and accounting for pregnancy residential mobility in exposure measurements; 2) assessing early risk of maternal CVD after pregnancy associated with HDP and the external exposome, and 3) developing predictive models of HDP and early risk of maternal CVD after pregnancy. This research project will be embedded in a comprehensive training program consisting of coursework, guided experiential and clinical learning, seminars, and mentorship by an established team of experts. The training program is designed to further my strengths and to develop new research skills while contributing to our scientific understanding of environmental impacts on cardiovascular health among pregnant and postpartum women. The training proposal details a five-year plan of formal and informal instruction in cardiovascular health, omics and exposome research, biomedical informatics and data science, and professional skills. My short-term career goals include completing coursework in all training areas, disseminating study findings through publications and presentations, engaging in career development activities, and applying for independent R01 funding in the third year of the award. My long-term career goal is to become an independent, collaborative, and productive epidemiologist and health data scientist leading research programs in cardiovascular health, with a focus on its intersection with perinatal and environmental epidemiology using big data.