Pregnancy as a Window to Future Cardiovascular Health

描述(由申请人提供)：最近的流行病学研究表明，有不良妊娠结局(APO)的妇女，如先兆子痫，后续心血管疾病的风险增加。然而，缺乏前瞻性数据来阐明不良妊娠结局和随后的心血管疾病之间的确切关系。为了解决这一关键的知识差距，NHLBI发布了一份RFA，将怀孕作为未来孕产妇健康的窗口进行研究。在这项建议中，一个拥有不同人才的多学科团队 专家将在分娩后两年确定载脂蛋白与心血管疾病风险标记物(CVDR)之间的关系。这一多中心小组将利用在人种、种族、社会经济和地理上不同的10 000名未分娩妇女组成的队列，参加由NICHD资助的未分娩妊娠结局研究：监测准妈妈(NuMoM2B)。 建议的研究是高度杠杆化的，利用在父母研究中开发的广泛和独特的数据库和组织库，其中对未分娩的妇女在怀孕期间进行评估，以研究APOS的机制和预测。通过前瞻性数据收集、临床评估和超声评估，以及通过使用标准化定义，在nuMoM2B队列中登记的女性得到了非常好的表型。人口统计、心理社会、饮食、生理和结果信息是通过母亲访谈、自我管理的问卷、临床测量、超声波和由训练有素的人员提取病历来收集的。孕妇的血液、尿液和宫颈阴道液以及分娩时脐带血和胎盘的样本被收集并储存。所有女性都完成了两份睡眠问卷，并招募了3600多人在怀孕期间两次进行客观的夜间睡眠研究。 参与nuMoM2B父母研究的妇女将在产后两到三年接受CVDR证据的评估，包括睡眠呼吸紊乱(SDB)。还将对后续怀孕的APO进行评估。这些研究将描述APOS和CVDR之间的关系，确定预示后续CVDR的首次妊娠情况，确定首次怀孕期间SDB与后续CVDR之间的关联，并确定在第一次和后续怀孕中调节CVDR和APOS关联的可修改因素。这将允许制定战略，以修正这些CVDR因素，并改善患有APOS的妇女的健康。

DESCRIPTION (provided by applicant): 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.