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

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ABSTRACT Cardiovascular disease (CVD) is the leading cause of death for U.S women, annually killing >400,000 women. Compared to whites, non-Hispanic Black and Latina women are at higher CVD risk. Despite the burden of CVD in women, risk factors specific to women are understudied and thus not considered in current CVD risk prediction or prevention strategies. Early detection of subclinical disease is key to CVD risk stratification and prevention. Since prenatal and postpartum care is the sole health care access point for most U.S. women, pregnancy represents a critical opportunity to measure CVD risk and implement innovative strategies to address this critical gap in women’s health care. Furthermore, CVD risk factor trajectories begin in utero and in early life, so pregnancy is also an opportunity to identify CVD risk in children. Our long-range goal is to identify and disseminate obstetric care practices that mitigate CVD risk for women and their children. The objective of this prospective, multicenter study is to estimate CVD risk in healthy and medically complicated pregnant women and their infants. We will also examine the relationships among personal, social, and ecological factors and CVD risk for 3 years postpartum. Our primary outcomes are maternal and infant central pulse wave velocity (PWV), a validated measure of arterial stiffness (vascular aging) that predicts CVD, independent of other established CVD risk factors. We will enroll a cohort 840 pregnant women of diverse race/ethnicity and socioeconomic status: 420 healthy and 420 women with preeclampsia, gestational diabetes, and/or suspected fetal growth restriction. We will measure maternal and infant PWV, cardio-metabolic (e.g., blood pressure, lipids, adiposity, HbA1c) and inflammatory (e.g., hs-CRP, IL-6, adiponectin) markers of CVD risk, and assess personal, social, and ecological factors at 34-40 weeks’ gestation, delivery, 6 months, 18 months, and 3 years. The study aims are the following: 1) Measure arterial stiffness by PWV during and after pregnancy; 2) Measure infant/child PWV following healthy and complicated pregnancies; and 3) Identify maternal and infant modifiable risk factors associated with CVD risk measured by PWV. To date, no studies have longitudinally measured CVD risk in pregnant women and their infants, nor ascertained the effect of biologic, personal, social, and/or ecological factors on CVD risk. Using a noninvasive measure of arterial stiffness, we propose to determine CVD risk in a cohort of mother-infant dyads. Our interdisciplinary study team of experts in CVD, high-risk pregnancy, exercise and sports physiology, CVD epidemiology, public health, and cardiology are well poised to complete the proposed aims by using a synthesis of expertise to achieve our common, shared goal of mitigate CVD risk for women and their children. We are proposing an innovative paradigm shift in the goals of prenatal care to use pregnancy as a time in a woman’s life, particularly if she is at high risk for CVD, to identify and mitigate early markers of CVD for herself and her offspring.