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

摘要 心血管疾病（CVD）是美国女性死亡的主要原因，每年有超过40万女性死亡。 与白人相比，非西班牙裔黑人和拉丁裔妇女的CVD风险更高。尽管CVD的负担 在女性中，女性特有的风险因素研究不足，因此在当前的CVD风险中未考虑 预测或预防策略。亚临床疾病的早期检测是CVD风险分层的关键， 预防由于产前和产后护理是大多数美国妇女唯一的医疗保健接入点， 怀孕是衡量心血管疾病风险和实施创新策略的关键机会， 解决妇女保健方面的这一重大差距。此外，心血管疾病危险因素的轨迹开始在子宫内和 早期的生活，所以怀孕也是一个机会，以确定心血管疾病的风险在儿童。我们的长远目标是 确定和传播减轻妇女及其子女心血管疾病风险的产科护理做法。的 这项前瞻性、多中心研究的目的是评估健康人群和有医学并发症人群的心血管疾病风险。 孕妇及其婴儿。我们还将研究个人、社会和 产后3年的生态因素和CVD风险。我们的主要成果是产妇和婴儿 中心脉搏波速度（PWV），一种有效的动脉硬度（血管老化）指标，可预测CVD， 独立于其他已知的CVD风险因素。我们将招募840名不同性别的孕妇， 种族/民族和社会经济地位：420名健康妇女和420名先兆子痫、妊娠糖尿病、 和/或疑似胎儿生长受限。我们将测量孕妇和婴儿的PWV、心脏代谢（例如， 血压、脂质、肥胖、HbA 1c）和炎症（例如，hs-CRP、IL-6、脂联素）标志物 风险，并在妊娠34-40周、分娩、6个月、18个月和18个月时评估个人、社会和生态因素。 几个月，三年。本研究的目的如下：1）测量动脉硬化的PWV值， 妊娠; 2）在健康和复杂妊娠后测量婴儿/儿童PWV;以及3） 识别与PWV测量的CVD风险相关的孕产妇和婴儿可改变的风险因素。至今没有 研究纵向测量了孕妇及其婴儿的心血管疾病风险，也没有确定其影响。 生物、个人、社会和/或生态因素对CVD风险的影响。使用非侵入性测量动脉 刚度，我们建议确定心血管疾病的风险在一个队列的母婴二对。我们的跨学科研究 心血管疾病、高危妊娠、运动和运动生理学、心血管疾病流行病学、公共卫生、 健康和心脏病学都准备好通过使用综合的专业知识来完成拟议的目标， 实现我们共同的目标，降低妇女及其子女的CVD风险。我们提出了一个 产前护理目标的创新模式转变，将怀孕作为妇女生命中的一段时间， 如果她是CVD的高风险，为她自己和她的后代识别和减轻CVD的早期标志物。

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.