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

描述(由申请人提供)：很少有可改变的早产(PTB)和宫内发育迟缓(IUGR)危险因素被确定。孕期心血管健康状况不佳可能导致早产，但孕前心血管健康状况对分娩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孕前心血管风险之间的关系，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，一生中心血管风险高预示着不良的妊娠结局，并部分解释了这些结局中的种族差异。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指标(黑/白)研究。这项研究包括了近6000名处于生育后期的女性的数据。我们建议链接到生命记录数据(估计N=3980)，访谈参与者关于他们的孕产史(估计N=3060)，并要求他们的怀孕医疗记录(估计N=1330)。然后，我们将研究心血管疾病(CVD)危险因素与寿命、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，确定母亲在儿童期和青春期的心血管危险因素(高血压、血脂异常、高血糖、高胰岛素血症、肥胖)对其婴儿的出生结局(早产和宫内发育迟缓)的影响；2)在黑人和白人个体中检验母亲心血管危险因素从童年到成年的纵向变化与生育结局的关系；3)确定孕前心血管危险因素是否与妊娠并发症(妊高征、妊娠期糖尿病和先兆子痫)有关，以及这是否解释了孕前心血管风险与PTB/IUGR之间的关系；4)确定心血管危险因素的差异是否可以解释出生结果的种族差异。预计这项拟议研究的贡献将是将整个生命周期的孕前心血管健康与妊娠结局联系起来。这将具有重要意义，因为我们将确定新的危险因素、时机和干预亚群，以减少PTB/IUGR的发生率和差异。这项建议利用了这一独特的机会，在一个混血人口中使用了35年的纵向研究，从童年开始。

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.