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

描述（由申请人提供）：已经确定了一些可改变的早产（PTB）和宫内生长迟缓（IUGR）的危险因素。怀孕期间心血管健康状况不佳可导致早产（PTB），但孕前心血管健康对分娩结局的影响尚不清楚。我们的长期目标是确定病因，并最终制定干预措施，减少肺结核/IUGR的发病率和差异。我们这个项目的总体目标是确定孕前心血管风险（从童年到成年早期）与出生结果之间的关系。我们的中心假设是，一生中心血管疾病的高风险预示着不良的妊娠结果，并部分解释了这些结果的种族差异。我们计划利用Bogalusa心脏研究中收集的数据，这是一项长期的儿童和年轻人心血管健康的双种族（黑人/白人）研究。这项研究包括了近6000名女性的数据，这些女性现在都处于生育年龄的后期。我们建议链接生命记录数据（估计N=3980），采访参与者的怀孕史（估计N=3060），并要求他们提供怀孕的医疗记录（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、出生结局和妊娠并发症之间的关系。我们的具体目标是1。在黑人和白人人群中，确定母亲儿童期和青春期CVD危险因素（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（早产（PTB）和宫内生长迟缓（IUGR））的影响；2)探讨黑人和白人母亲CVD危险因素从儿童期到成年期与出生结局的纵向变化关系；3)确定孕前CVD危险因素是否与妊娠并发症（妊娠高血压、妊娠糖尿病、先兆子痫）相关，这是否解释了孕前心血管风险与PTB/IUGR之间的关系；4)确定心血管疾病危险因素的差异是否可以解释出生结果的种族差异。这项拟议研究的贡献有望将怀孕前的心血管健康与怀孕结果联系起来。这将是重要的，因为我们将确定新的危险因素，时间和亚人群的干预措施，可以减少PTB/IUGR的发病率和差距。这项建议利用了独特的机会，利用35年的纵向研究，从童年开始，在一个混血儿群体中。

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.