Long-Term Burden of Maternal Cardiovascular Risk Factors and Birth Outcomes

描述（由申请人提供）：已确定早产（PTB）和宫内发育迟缓（IUGR）的可改变风险因素很少。怀孕期间心血管健康状况不佳可能导致早产（PTB），但孕前心血管健康对出生结局的影响尚不清楚。我们的长期目标是确定PTB/IUGR的原因并最终制定干预措施，以减少PTB/IUGR的发生率和差异。我们这个项目的总体目标是确定从儿童期到成年早期的孕前心血管风险与出生结局之间的关系。我们的中心假设是，整个生命周期的心血管风险高预测不良妊娠结局，并部分解释了这些结局的种族差异。我们计划利用博加卢萨心脏研究中收集的数据，这是一项关于儿童和年轻人心血管健康的长期双胞胎（黑人/白色）研究。这项研究包括近6000名妇女的数据，这些妇女现在处于生育后期。我们建议链接到生命记录数据（估计N=3980），对受试者进行妊娠史访谈（估计N=3060），并要求提供妊娠病历（估计N=1330）。然后，我们将研究心血管疾病（CVD）风险因素在整个生命周期，分娩结局和妊娠并发症之间的关系。我们的具体目标是1。确定母亲CVD危险因素的影响（高血压、血脂异常、高血糖、高胰岛素血症、肥胖）对婴儿出生结局的影响（早产（PTB）和宫内发育迟缓（IUGR））在黑人和白色人口; 2）研究黑人和白色人母亲CVD危险因素从儿童期到成年期的纵向变化与出生结局的关系。3）确定孕前心血管危险因素是否与妊娠并发症（妊娠期高血压、妊娠期糖尿病和先兆子痫）相关，以及这是否解释了孕前心血管风险与PTB/IUGR之间的关系; 4）确定CVD危险因素的差异是否解释了出生结局的种族差异。这项拟议研究的贡献预计将把整个生命周期的孕前心血管健康与妊娠结局联系起来。这将是重要的，因为我们将确定新的风险因素，时间和亚群的干预措施，可以减少PTB/IUGR的发病率和差异。这项建议利用了一个独特的机会，利用35年的纵向研究，从童年开始，在一个双胞胎人口。 公共卫生相关性：拟议的研究将有助于减少一个重要的公共卫生问题，早产和宫内发育迟缓的差距。通过确定生命过程中的风险因素（儿童期，青少年期和成年期），将有可能制定改善心血管和生殖健康的干预措施。这项研究将是重要的，因为我们将确定新的风险因素，时间和亚群的干预措施，可以改善妊娠结局。

DESCRIPTION (provided by applicant): Few modifiable risk factors for preterm birth (PTB) and intrauterine growth retardation (IUGR) have been identified. Poor cardiovascular health during the pregnancy can lead to preterm birth (PTB), but the effect of pre-pregnancy cardiovascular health on birth outcomes is not clear. Our long-term goal is to determine the causes of and ultimately develop interventions that can reduce the incidence of and disparities in PTB/IUGR. Our overall objective with this project is to determine the relationship between pre-pregnancy cardiovascular risk, from childhood through early adulthood, and birth outcomes. Our central hypothesis is that high cardiovascular risk across the lifespan predicts poor pregnancy outcome and partially accounts for racial disparities in these outcomes. We plan to take advantage of the data collected in the Bogalusa Heart Study, a long-running biracial (black/white) study of cardiovascular health in children and young adults. The study includes data on almost 6000 women, now in their late reproductive years. We propose to link to vital records data (estimated N=3980), interview participants about their pregnancy history (estimated N=3060), and request medical records for their pregnancies (estimated N=1330). We will then examine the relationship between cardiovascular disease (CVD) risk factors across the lifespan, birth outcomes, and pregnancy complications. Our specific aims are 1. To determine the impact of mother's CVD risk factors (high blood pressure, dyslipidemia, hyperglycemia, hyperinsulinemia, obesity) in childhood and adolescence on birth outcomes of her babies (preterm birth (PTB) and intrauterine growth retardation (IUGR)) in a black and white population; 2) To examine the relationship of longitudinal changes of mother's CVD risk factors from childhood to adulthood to birth outcomes in black and white individuals); 3) To determine whether pre-pregnancy CVD risk factors are associated with pregnancy complications (gestational hypertension, gestational diabetes and pre-eclampsia), and whether this explains the relationship between pre-pregnancy cardiovascular risk and PTB/IUGR; 4) To determine whether differences in CVD risk factors explain racial disparities in birth outcomes. The contribution of the proposed research is expected to be linking pre-pregnancy cardiovascular health across the life span with pregnancy outcomes. This will be significant because we will identify novel risk factors, timing, and subpopulations for interventions that could reduce the incidence of and disparities in PTB/IUGR. This proposal takes advantage of the unique opportunity to use 35 years of longitudinal research, beginning in childhood, in a biracial population. PUBLIC HEALTH RELEVANCE: The proposed research will contribute to reducing an important public health problem, disparities in preterm birth and intrauterine growth retardation. By identifying risk factors over the life course (childhood, adolescence, and adulthood), it will be possible to develop interventions that improve both cardiovascular and reproductive health. This research will be significant because we will identify novel risk factors, timing, and subpopulations for interventions that could improve pregnancy outcome.