Cardiovascular Risks Associated with Pregnancy in African American Women with Systemic Lupus Erythematosus

项目摘要 系统性红斑狼疮(SLE)主要影响女性生育期。非洲 与白人女性相比，美国女性患SLE的风险是白人女性的3倍。从历史上看，患有SLE的女性 被建议不要怀孕。最近，医学建议的重点是选择怀孕的时间 系统性红斑狼疮得到良好控制的时期。研究表明，患有系统性红斑狼疮的女性可能有出生不良的风险 结果，但非洲裔美国妇女在这些研究中的代表性不足。此外，拥有 系统性红斑狼疮是心血管疾病(CVD)的高危人群，不良的出生结局与晚产有关 在普通人群中发生脑血管病。出生和妊娠结局与后期心血管疾病健康的关系 在患有系统性红斑狼疮的妇女中还没有进行检查。这篇论文的总体目标是描述 患有系统性红斑狼疮的非裔美国女性的怀孕与心血管健康之间的关系。在AIM 1，我们将评估系统性红斑狼疮与早产和小儿麻痹症的妊娠结局的关系。 非裔美国女性的胎龄(SGA)。在《目标2》中，我们将考察非裔美国人 与非裔美国人相比，生下孩子的SLE女性更有可能因心血管疾病住院 患有系统性红斑狼疮但从未生育的女性。最后，在《目标3》中，我们将考察非裔美国女性 系统性红斑狼疮患者有不良的出生结局或母体并发症，更有可能因心血管疾病住院。 与患有系统性红斑狼疮的非裔美国女性相比，她们在 怀孕了。这项研究将使用佐治亚州狼疮登记处(GLR)和格鲁吉亚人的数据 针对狼疮(目标)队列进行组织。在目标1中，GLR/目标中的女性参与者将与格鲁吉亚联系起来 出生证明，在上面他们被确认为母亲。一套与女性相比的出生证明 如果没有系统性红斑狼疮，也将被确认。将对以下妇女的早产和SGA出生的风险进行比较 未发生系统性红斑狼疮时，采用对数风险回归模型。系统性红斑狼疮临床诊断前后的风险将是 检查过了。对于AIMS 2和AIMS 3，将确定因心血管疾病住院和因心血管疾病死亡的人数 GLR/Goal参与者使用相关联的佐治亚州医院出院数据和死亡记录。在目标2中，我们将 比较系统性红斑狼疮患者生育过未生育的SLE患者的心血管疾病风险 分娩采用COX比例风险回归模型。在目标3中，我们将比较心血管疾病的风险 在生育并有不良分娩结局或产妇并发症的系统性红斑狼疮患者中 患有SLE但没有不良分娩结局或母体并发症的SLE患者使用 考克斯模特。随着系统性红斑狼疮的治疗和预期寿命的改善，估计每10万人中有更多的人患有SLE 患有系统性红斑狼疮的非裔美国女性将尝试怀孕和生育。这项研究具有 可能有助于在怀孕前和怀孕后护理和管理系统性红斑狼疮妇女。

Project Summary Systemic lupus erythematosus (SLE) primarily affects women during their reproductive years. African American women are at 3 times the risk of SLE compared with white women. Historically, women with SLE were advised against becoming pregnant. More recently, medical advice focuses on timing pregnancy to periods when SLE is well-controlled. Research suggests that women with SLE may be at risk of poor birth outcomes, but African American women have been underrepresented in these studies. Further, individuals with SLE are at high risk for cardiovascular disease (CVD) and adverse birth outcomes are associated with later CVD in the general population. The association between birth and pregnancy outcomes and later CVD health in women with SLE has not been examined. The overall goal of this dissertation is to characterize the associations between pregnancy and cardiovascular health among African American women with SLE. In Aim 1, we will evaluate the association between SLE and the pregnancy outcomes preterm birth and small-for- gestational age (SGA) among African American women. In Aim 2, we will examine whether African American women with SLE who gave birth are more likely to be hospitalized for CVD compared to African American women with SLE who never gave birth. Finally, in Aim 3, we will examine whether African American women with SLE who had adverse birth outcomes or maternal complications are more likely to be hospitalized for CVD compared to African American women with SLE who did not have any of these complications during pregnancy. This research will use data from both the Georgia Lupus Registry (GLR) and the Georgians Organized Against Lupus (GOAL) Cohort. In Aim 1, female participants in GLR/GOAL will be linked to Georgia birth certificates on which they are identified as the mother. A comparison set of birth certificates to women without SLE will also be identified. The risk of preterm birth and SGA birth will be compared for women with and without SLE using log-risk regression models. Risks both before and after clinical diagnosis of SLE will be examined. For Aims 2 and 3, hospitalizations for CVD and deaths attributable to CVD will be identified for GLR/GOAL participants using linked Georgia hospital discharge data and death records. In Aim 2, we will compare the hazard of CVD among women with SLE who have given birth to women with SLE who have not given birth using Cox proportional hazards regression models. In Aim 3, we will compare the hazard of CVD among women with SLE who gave birth and had adverse birth outcomes or maternal complications to women with SLE who gave birth but did not have adverse birth outcomes or maternal complications using marginal Cox models. As treatments and life expectancy for SLE improve, more of the estimated 200 per 100,000 African American women living with SLE will attempt pregnancy and childbearing. This research has the potential to contribute to informing the care and management of women with SLE before and after pregnancy.