Arterial stiffness in mother/infant dyads: Life course approach to prevent cardiovascular disease

摘要 超过45%的美国女性经历了妊娠期体重过度增加(GWG) 在怀孕期间、产后及以后心血管疾病风险增加(≥为10年)。过剩 脂肪积累和特定的脂肪分布模式，如腹部内脏脂肪，加速血管老化 在普通人群中。然而，GWG的组成几乎没有报道。因此，一个知识鸿沟 了解血管老化反应是否与身体成分的变化有关 以及孕期和产后脂肪分布。这项建议是对母婴的补充 血管老化的决定因素研究(MIDAS；R01HL157075)。迈达斯研究将招收840名种族和 在怀孕34-40周之间，种族多样、健康和医学上复杂的母婴二人组。在… 怀孕34-40周，分娩后48小时内，以及产后6个月和12个月，Midas的研究将 通过测量脉搏波速度(PWV)来评估血管老化和心血管风险，并检查两者之间的关系 在与PWV有关的生物、个人、社会和生态疾病风险因素中。这项提议的目的是 是阐明身体组成(目标1)和脂肪分布(目标2)在过程中和之后的变化 怀孕影响产后心血管疾病风险。尽管由身体质量指数定义的肥胖是一种被提议的 可改变的危险因素、身体成分(即，脂肪百分比)和脂肪分布(即，内脏脂肪组织)不是 家长拨款的重点。因此，这项建议将通过领导 对孕期和产后体成分进行数据收集和深入分析。研究的具体目标 是：1)确定妊娠34-40周至12个月的脂肪百分比轨迹之间的关系 840名不同种族和民族的孕妇产后和产后12个月的PWV，以及2) 确定产后6至12个月的脂肪分布变化与产后PWV之间的关系 产后12个月的一组妇女(n=280)。我们还将探索种族是否会缓和 目标1和目标2中提议的联系；种族和少数民族妇女肥胖率更高 与非西班牙裔白人女性相比，她们患妊娠并发症和心血管疾病的风险更大。 这一时间敏感的补充剂利用了接触到大量不同的孕妇和产后妇女的机会 以及一支在心血管疾病风险和产妇健康方面具有专业知识的多学科导师团队。因此，我们正在 能够很好地完成提议的目标。此外，这一补充将使职业生涯更早 调查员：1)获得执行明确定义的研究项目的经验，评估怀孕期间的心血管疾病风险 女性，2)发展她的勇气，3)扩大她的研究网络，并向成功的 导师团队。这份增刊将成为迈达斯研究的一个组成部分，重点放在肥胖问题上。 与产妇心血管健康相关的风险，它将为早期职业调查员提供支持，以 推进她的职业发展轨迹，建立一条独立的、可资助的研究线路。

ABSTRACT Greater than 45% of women in the United States experience excessive gestational weight gain (GWG) leading to increased cardiovascular disease (CVD) risk during pregnancy, postpartum and beyond (≥10 years). Excess fat accumulation and specific fat distribution patterns, such as abdominal visceral fat, accelerate vascular aging in the general population. However, the composition of GWG is scarcely reported. Therefore, a knowledge gap exists in understanding whether the vascular aging response is associated with changes in body composition and fat distribution during pregnancy and postpartum. This proposal supplements the Mother and Infant Determinants of vascular Aging Study (MIDAS; R01HL157075). The MIDAS study will enroll 840 racially and 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 vascular aging and CVD risk by measuring pulse wave velocity (PWV), and examine relationships among biologic, personal, social, and ecological disease risk factors with PWV. The objective of this proposal is to elucidate how body composition (Aim 1) and fat distribution (Aim 2) changes during and following pregnancy impact postpartum CVD risk. Although obesity, defined by body mass index, is a proposed modifiable risk factor, body composition (i.e., %fat) and fat distribution (i.e., visceral adipose tissue) were not a focus of the parent grant. Therefore, this proposal will complement the existing MIDAS study by leading the data collection and in-depth analysis of gestational and postpartum body composition. The study specific aims are: 1) determine the association between the trajectory of %fat from 34-40 weeks gestation to 12 months postpartum and PWV at 12 months postpartum in 840 racially and ethnically diverse pregnant women, and 2) determine the association between the change in fat distribution from 6 to 12 months postpartum with PWV at 12 months postpartum in a subset of women (n=280). We will also explore whether race moderates the proposed associations in Aims 1 and 2; racial and ethnic minority women have a greater prevalence of obesity and are at a greater risk for pregnancy complications and CVD compared with non-Hispanic white women. This time sensitive supplement leverages access to a large, diverse cohort of pregnant and postpartum women and a multi-disciplinary team of mentors with expertise in CVD risk and maternal health. 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, 2) develop her grantsmanship and, 3) 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 adiposity- related risk to maternal cardiovascular health and it will provide an early career investigator with support to advance her career trajectory and establish an independent, fundable research line.