REGULAR EXERCISE AMONG WOMEN AT RISK FOR PREECLAMPSIA

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。先兆子痫--妊娠期间突然出现高血压和蛋白尿--是一种严重的并发症，几乎每20个孕妇中就有一个受到影响。它是全世界孕产妇死亡的主要原因，并影响到所有种族和社会经济群体的妇女。不幸的是，目前还没有针对这种不祥疾病的明确预防性治疗方法。科学家现在认为，先兆子痫是一种内皮疾病，部分原因是氧化应激。因此，定期锻炼已成为一种潜在的预防措施。这与每天服用小剂量阿司匹林或补钙药物形成鲜明对比，后者未能显示出明显的效果，可能会产生不良影响。这项研究的目的是确定妊娠期中等强度的运动是否会降低子痫前期的发生率，并评估解释运动对子痫前期影响的假设过程(包括氧化应激和抗氧化过程)。这是一项随机临床试验，共有250名孕妇有先兆子痫的风险。符合资格的受试者将在怀孕14至18周时进入磨合期(即预选期)。将获得的基线数据包括人口统计信息、健康史、日常体力活动、心血管健康水平、血压、血清铁、转铁蛋白、低密度脂蛋白、丙二醛、超氧化物歧化酶的血样。在18周时，符合条件的受试者将被随机分配到运动(40min，70%最大摄氧量，5x/周)或假运动(对照组，40min)中。伸展运动，5次/周)条件。对于两组，所有基线测量将在28周时重复(结果I)。受试者将在28周后继续进行锻炼，直到她的足月，只要安全和舒适。分娩期间将再次采集血样(结果二)。因产科原因进行剖宫产的受试者将在切开时提供少量皮下组织来测定内皮超氧化物歧化酶。将审查医疗记录，以获得额外的结局数据(妊娠/分娩结局和先兆子痫的诊断)。相关的卡方检验和Logistic回归分析将用于解决运动的影响、先兆子痫的预测和其他妊娠结局。重复测量的方差分析将被用来评估运动对各种生物标志物的影响。将应用方差分析来控制混杂因素。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Preeclampsia -the sudden onset of high blood pressure along with proteinuria during pregnancy- is a serious complication affecting nearly one in every 20 pregnancies. It is the main cause of maternal death worldwide, and affects women of all races and socioeconomic groups. Unfortunately, no definitive preventive treatment is currently available for this ominous disease. Scientists now believe that preeclampsia is a disease of the endothelium, due in part to oxidative stress. As such, regular exercise has emerged as a potential preventive measure. This contrasts to daily low dose aspirin or calcium supplement which have failed to demonstrate a significant effect and may have adverse effects. The purpose of this study is to determine if moderate intensity exercise during pregnancy will reduce the incidence of preeclampsia and to assess the process (involving oxidative stress and antioxidant process) hypothesized to explain the effect of exercise on preeclampsia. This is a randomized clinical trial with a total of 250 pregnant subjects at risk for preeclampsia. Eligible subjects will enter a run-in period (i.e., qualifying period) at 14 to 18 weeks gestation. Baseline data to be obtained include demographic information, health history, daily physical activities, cardiovascular fitness level, blood pressure, blood sample for serum iron, transferrin, low density lipoprotein, malondialdehyde, superoxide dismutase. At 18 weeks, compliant subjects will be randomly assigned to either the exercise (40 min., 70%VO2 max, 5x/week) or sham exercise (control group; 40 min. stretch exercise, 5x/week) condition. For both groups, all baseline measurements will be repeated at 28 weeks (Outcome I). Subjects will continue the exercise regimen after 28 weeks up to her term and as long as it is safe and comfortable. A blood sample will be collected again during labor (Outcome II). Subjects who undergo cesarean section for obstetrical reasons will provide a small amount of subcutaneous tissue at the time of incision to measure endothelial superoxide dismutase. Medical records will be reviewed for additional outcome data (pregnancy/birth outcomes and diagnosis of preeclampsia). Chi-square tests of association and logistic regression analysis will be applied to address the effect of exercise, prediction of preeclampsia, and other pregnancy outcomes. Repeated Measures ANOVA will be applied to assess the effect of exercise on various biological markers. ANCOVA will be applied to control confounding factors.