Pregnancy as a Window to Future Cardiovascular Health: Adverse Pregnancy Outcomes, DCAC Application for Supplemental funds for Cotinine testing

最近的流行病学研究表明，有不良妊娠结局(APO)的妇女 先兆子痫患者罹患后续心血管疾病的风险增加。然而，预期数据将 阐明不良妊娠结局与随后的心血管疾病之间的确切关系 疾病是缺乏的。为了解决这一关键的知识差距，NHLBI发布了一份RFA，将怀孕作为 未来产妇健康的窗口。在这项提议中，一个拥有不同人才和 专业知识将定义载脂蛋白和心血管疾病风险标记物(CVDR)之间的关系 分娩两年后。这个多中心集团将利用一个在种族、种族、社会经济和 在NICHD资助的未产妇中登记的10,000名未分娩妇女的地理多样性队列 妊娠结局研究：监测准妈妈(NuMoM2B)。 建议的研究是高度杠杆化的，利用了广泛和独特的数据库和组织库 在父母研究中开发的，在该研究中，未分娩的妇女在怀孕期间被评估以 研究APOS的发生机制及预测。在nuMoM2B队列中登记的女性 通过前瞻性数据收集、临床评估和超声评估获得良好的表型，如 以及通过使用标准化定义。人口统计、心理社会、饮食、生理和 结果信息是通过母亲访谈、自填式问卷、临床 由训练有素的人员进行测量、超声波和病历提取。母体样本 妊娠期间收集血液、尿液和宫颈阴道液，分娩时收集脐带血和胎盘。 存入银行。所有女性都完成了两份睡眠问卷，并招募了3600多名女性来完成目标 怀孕期间进行两次通宵睡眠研究。 参与nuMoM2B父母研究的妇女将接受CVDR证据的评估，包括 睡眠呼吸障碍(SDB)，产后两到三年。再次妊娠时的APOS也 将会被评估。这些研究将描述APO和CVDR之间的关系，首先确定 预示着随后的CVDR的妊娠档案，确定了第一次SDB与 怀孕和随后的CVDR，并确定调节之间关联的可修改因素 首次妊娠和以后妊娠的CVDR和APOS。这将允许制定战略，以 修改这些CVDR因素，以改善患有APOS的妇女的健康。 相关性(请参阅说明)： NICHD目前正在进行一项大型研究，寻找测试以确定怀孕风险 第一次怀孕的妇女的问题。在这项新的研究中，同样的女性将接受测试 在他们生下孩子大约两年后，再次观察这些人是否有心脏病的早期迹象 怀孕有问题的人。这项后续研究的信息将用于改善 妇女在怀孕期间使用她们的经验。

Recent epidemiologic studies suggest that women with adverse pregnancy outcomes (APOs), such as preeclampsia, are at increased risk for subsequent cardiovascular diseases. However, prospective data to elucidate the precise relationship between adverse pregnancy outcomes and subsequent cardiovascular disease are lacking. To address this critical knowledge gap, the NHLBI issued a RFA to study pregnancy as a window to future maternal health. In this proposal, a multidisciplinary team with diverse talents and expertise will define the relationship between APOs and markers of cardiovascular disease risk (CVDR) at two years after delivery. This multicenter group will utilize an ethnically, racially, socioeconomically and geographically diverse cohort of 10,000 nulliparous women enrolled in the NICHD-funded Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The proposed studies are highly leveraged, utilizing the extensive and unique database and tissue bank developed in the parent study in which nulliparous women are evaluated over the course of pregnancy to study the mechanisms for and prediction of APOs. Women enrolled in the nuMoM2b cohort are extremely well phenotyped through prospective data collection, clinical evaluations, and ultrasound assessments, as well as through the use of standardized definitions. Demographic, psychosocial, dietary, physiologic, and outcome information is collected through maternal interviews, self-administered questionnaires, clinical measurements, ultrasounds, and medical record abstraction by trained personnel. Samples of maternal blood, urine, and cervico-vaginal fluid over pregnancy and cord blood and placenta at delivery are collected and banked. All women complete two sleep questionnaires and over 3,600 are recruited to perform objective overnight sleep studies at two times during pregnancy. Women participating in the nuMoM2b parent study will be assessed for evidence of CVDR, including sleep disordered breathing (SDB), at two to three years postpartum. APOs in subsequent pregnancies also will be assessed. These studies will characterize the relationship between APOs and CVDR, identify first pregnancy profiles that portend subsequent CVDR, determine associations between SDB during the first pregnancy and subsequent CVDR, and identify modifiable factors that mediate the associations between CVDR and APOs in the first and subsequent pregnancy. This will allow for the development of strategies to modify these CVDR factors and to improve the health of women suffering APOs. RELEVANCE (See instructions): NICHD is currently conducting a large study that looks for tests to identify the risk of developing pregnancy problems in women who are pregnant for the first time. In this new study, the same women will be tested again at approximately 2 years after they give birth to see if there are early signs of heart disease in those who had problem pregnancies. Information from this follow-up study will be used to improve the health of women using their experiences during pregnancy.