Cardiovascular Disease Risk Factors in At-Risk Hispanic Women following Pregnancy Complications

妊娠并发症正在成为未来心血管健康的重要预测因素， 怀孕的要求作为一个“压力测试”，揭示了未来心血管疾病的易感性 (CVD)在母亲。怀孕也可能揭示了未来抑郁症的易感性， 这与抑郁症和心血管疾病的共同发生和双向关系一致， 尤其是女性。因此，这项研究的长期目标是了解身体和 怀孕期间的心理健康可以帮助预测成年后期的心血管疾病事件和心理健康障碍。 拟议研究的具体目标是检查妊娠并发症的关联 产前心理健康与随后的心脏代谢特征和中年期心理健康 生活在美国大陆的波多黎各裔拉美裔人中。这个最重要的假设是 建议是，妊娠并发症将与较差的心脏代谢健康和精神 波多黎各人成年中期的健康状况，这是一个具有CVD高风险的西班牙裔亚组。目前 关于这些关联的大多数证据来自回顾性队列研究， 出生和死亡登记数据库。没有研究评估这些协会在波多黎各人 尽管这一群体的糖尿病、肥胖和主要心脏代谢风险患病率最高， 西班牙裔的人口增长率是美国总人口的三倍。的 拟议的研究提供了一个独特的机会，利用我们以前收集的前瞻性 妊娠数据来自Proyecto Buena Salud（PBS，R 01 DK 064902，PI：Chasan-Taber）。PBS是 2006-2011年对波多黎各妇女进行的前瞻性研究提供了新的证据， 怀孕并发症和产前抑郁症在波多黎各人中非常普遍， 与不利的孕产妇和分娩结果显著相关。现在平均已经13.4年了 自从参与者在PBS怀孕后我们的可行性研究预测，87%（n= 1，096）的PBS参与者 将参与我们提议的后续研究。就拟议的研究而言，双语/双文化工作人员将进行- 个人访问，收集胰岛素抵抗、炎症、脂质、肥胖、血压的生物标志物， 慢性生理应激（毛发皮质醇浓度）。访谈者管理的问卷，在 西班牙裔，将衡量抑郁，心理压力和焦虑。我们将使用腕动记录仪来评估 一种新的假设认为，在波多黎各人中非常普遍的睡眠不足和身体活动不足可能介导 上述关系。这项研究对于前瞻性评估妊娠是否 并发症为早期CVD预防工作提供了有意义的机会。这项研究也有 翻译的意义，告知文化敏感的产前干预措施， 未来的慢性疾病在研究不足，特别是脆弱的人群。

Pregnancy complications are emerging as important predictors of future cardiovascular health with the demands of pregnancy acting as a “stress test” that reveals a pre-disposition to future cardiovascular disease (CVD) in the mother. Pregnancy may also reveal a predisposition to future depressive disorders, a hypothesis that is consistent with the co-occurrence of, and bi-directional relationship between, depression and CVD, particularly in women. Therefore, the long-term objective of this research is to understand how physical and mental health during pregnancy can help predict CVD events and mental health disorders in later adulthood. The specific objective of the proposed research is to examine the association of pregnancy complications and prenatal mental health with subsequent cardiometabolic profile and mental health in middle adulthood among Hispanics of Puerto Rican heritage living in the continental US. The overarching hypothesis of this proposal is that pregnancy complications will be associated with poorer cardiometabolic health and mental health status in middle adulthood in Puerto Ricans, a Hispanic subgroup at high risk of CVD. Currently, the majority of evidence regarding these associations derives from retrospective cohort studies that linked national birth and death registry databases in Europe. No studies have evaluated these associations in Puerto Ricans despite the fact that this group has the highest prevalence of diabetes, obesity, and major cardiometabolic risk factors among Hispanics and a population growth rate three times higher than the general US population. The proposed study provides a unique opportunity to leverage our previously-collected prospective pregnancy data from Proyecto Buena Salud (PBS, R01 DK064902, PI: Chasan-Taber). PBS was a prospective study of Puerto Rican women conducted from 2006-2011 that provided novel evidence that pregnancy complications and prenatal depression were highly prevalent in Puerto Ricans and were significantly associated with adverse maternal and birth outcomes. It has now been an average of 13.4 years since the participants’ PBS pregnancy. Our feasibility study projects that 87% (n=1,096) of PBS participants will participate in our proposed follow-up study. For the proposed study, bilingual/bicultural staff will conduct in- person visits to collect biomarkers of insulin resistance, inflammation, lipids, adiposity, blood pressure, and chronic physiological stress (hair cortisol concentrations). Interviewer-administered questionnaires, validated in Hispanics, will measure depression, psychosocial stress, and anxiety. We will use actigraphy to evaluate the novel hypothesis that poor sleep and low physical activity, highly prevalent among Puerto Ricans, may mediate the above relationships. This research is significant in prospectively assessing whether pregnancy complications offer a meaningful opportunity for early CVD prevention efforts. This research also has translational significance in informing culturally sensitive prenatal interventions for early life prevention of future chronic disorders in an understudied and particularly vulnerable population.