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

患有系统性红斑狼疮的非洲裔美国女性与怀孕相关的心血管风险

• 批准号: 10268191
• 负责人: Meghan Angley
• 金额: $ 4.6万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268191
• 关键词: Affect; African American; Age; Area; Autoantibodies; Autoimmune Diseases; Birth; Birth Certificates; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic; Counseling; Cox Models; Data; Death Records; Diagnosis; Disease; Event; Female; General Population; Goals; Health; High Risk Woman; Hospitalization; Hospitals; Immune; Individual; Inflammation; Life Expectancy; Link; Lupus; Maternal complication; Measures; Medical; Modeling; Mothers; Outcome; Participant; Persons; Placenta Diseases; Population; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Production; Prognosis; Race; Records; Research; Risk; Risk Factors; Sampling Studies; Severities; Small for Gestational Age Infant; Systemic Lupus Erythematosus; Time; Woman; adverse birth outcomes; adverse pregnancy outcome; aged; attributable mortality; body system; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; child bearing; clinical Diagnosis; cohort; experience; hazard; high risk; high risk population; improved; indexing; lupus registry; maternal outcome; metropolitan; pregnancy health; pregnant; reproductive

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.

项目概要 系统性红斑狼疮 (SLE) 主要影响育龄期的女性。非洲人 美国女性患系统性红斑狼疮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，医疗建议重点关注怀孕时机 SLE 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面临难产的风险 结果，但非裔美国女性在这些研究中的代表性不足。此外，个人 SLE 罹患心血管疾病 (CVD) 的风险很高，不良出生结果与以后的症状相关 一般人群中的CVD。出生和妊娠结局与后期心血管疾病健康之间的关系 尚未对患有 SLE 的女性进行检查。本论文的总体目标是描述 患有系统性红斑狼疮的非洲裔美国女性怀孕与心血管健康之间的关系。瞄准 1、我们将评估 SLE 与妊娠结局之间的关联 早产和小儿 非裔美国女性的孕龄（SGA）。在目标 2 中，我们将研究非裔美国人是否 与非洲裔美国人相比，患有系统性红斑狼疮的女性生育后更有可能因心血管疾病住院 患有系统性红斑狼疮且从未生育过的女性。最后，在目标 3 中，我们将研究非裔美国女性是否 患有 SLE 且有不良分娩结局或孕产妇并发症的患者更有可能因 CVD 住院 与患有系统性红斑狼疮的非裔美国女性相比，她们在治疗期间没有出现任何这些并发症 怀孕。这项研究将使用来自佐治亚州狼疮登记处 (GLR) 和佐治亚州人的数据 组织抗狼疮 (GOAL) 队列。在目标 1 中，GLR/GOAL 的女性参与者将与格鲁吉亚联系起来 出生证明上注明他们是母亲。女性出生证明的比较集 没有 SLE 的情况也会被识别出来。将比较以下妇女的早产风险和 SGA 出生风险： 没有 SLE，则使用对数风险回归模型。 SLE 临床诊断前后的风险将 检查了。对于目标 2 和 3，将确定因 CVD 住院和因 CVD 死亡的情况： GLR/GOAL 参与者使用链接的佐治亚州出院数据和死亡记录。在目标 2 中，我们将 比较已生育过的 SLE 女性与未生育过的 SLE 女性的 CVD 风险 使用 Cox 比例风险回归模型分娩。在目标3中，我们将比较CVD的危害 患有系统性红斑狼疮的妇女生育后出现不良分娩结果或产妇并发症 患有系统性红斑狼疮 (SLE) 的患者已分娩但未出现不良分娩结局或孕产妇并发症（使用边缘计算） 考克斯模型。随着 SLE 治疗方法和预期寿命的改善，每 100,000 人中预计有 200 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。这项研究有 可能有助于为患有系统性红斑狼疮的妇女怀孕前后的护理和管理提供信息。