Cardiovascular Disease Risk Factors in At-Risk Hispanic Women following Pregnancy Complications

妊娠并发症正在成为未来心血管健康的重要预测指标 孕期需求可作为一种“压力测试”，揭示未来心血管疾病的易感性 (CVD)在母亲体内。怀孕也可能揭示出未来抑郁障碍的倾向，这是一种假设 这与抑郁症和心血管疾病的共同发生和双向关系是一致的， 尤其是在女性身上。因此，这项研究的长期目标是了解身体和 怀孕期间的心理健康可以帮助预测成年后的心血管疾病事件和心理健康障碍。 这项拟议的研究的具体目标是检查妊娠并发症之间的联系。 产前心理健康和随后的心脏代谢特征，以及成年中期的心理健康 在居住在美国大陆的波多黎各血统的西班牙裔中。其中最重要的假设是 研究表明，妊娠并发症将与较差的心脏代谢健康和精神状态有关。 波多黎各人成年中期的健康状况，这是一个患心血管疾病风险很高的西班牙裔亚群。目前， 关于这些关联的大多数证据来自回溯性队列研究，这些研究将国家 欧洲的出生和死亡登记数据库。目前还没有研究对波多黎各人的这些关联进行评估 尽管这一群体的糖尿病、肥胖症和重大心脏代谢风险的发病率最高 西班牙裔美国人的人口增长率是美国总人口的三倍。这个 建议的研究提供了一个独特的机会来利用我们之前收集的预期 来自Proyecto Buena Salud(PBS，R01 DK064902，PI：Chasan-Taber)的怀孕数据。PBS是一家 2006-2011年对波多黎各妇女进行的前瞻性研究提供了新的证据 怀孕并发症和产前抑郁在波多黎各人中非常普遍， 与不良的孕产妇和分娩结局显著相关。现在平均为13.4年。 从参与者的PBS怀孕开始。我们的可行性研究预计87%(n=1096)的PBS参与者 将参与我们提议的后续研究。在拟议的研究中，双语/双文化工作人员将在- 人们去收集胰岛素抵抗、炎症、血脂、肥胖、血压和 慢性生理应激(头发皮质醇浓度)。面试者管理的问卷，验证于 西班牙裔，将测量抑郁、心理社会压力和焦虑。我们将使用动作图来评估 在波多黎各人中非常普遍的睡眠不佳和体力活动减少可能是一种新的假说 上述关系。这项研究对前瞻性评估是否怀孕具有重要意义 并发症为早期预防心血管疾病提供了一个有意义的机会。这项研究也有 文化敏感的产前干预在早期生命预防中的翻译意义 在研究不足和特别脆弱的人群中的未来慢性疾病。

Pregnancy complications are emerging as important predictors of future cardiovascular health with the demands of pregnancy acting as a “stress test” that reveals a pre-disposition to future cardiovascular disease (CVD) in the mother. Pregnancy may also reveal a predisposition to future depressive disorders, a hypothesis that is consistent with the co-occurrence of, and bi-directional relationship between, depression and CVD, particularly in women. Therefore, the long-term objective of this research is to understand how physical and mental health during pregnancy can help predict CVD events and mental health disorders in later adulthood. The specific objective of the proposed research is to examine the association of pregnancy complications and prenatal mental health with subsequent cardiometabolic profile and mental health in middle adulthood among Hispanics of Puerto Rican heritage living in the continental US. The overarching hypothesis of this proposal is that pregnancy complications will be associated with poorer cardiometabolic health and mental health status in middle adulthood in Puerto Ricans, a Hispanic subgroup at high risk of CVD. Currently, the majority of evidence regarding these associations derives from retrospective cohort studies that linked national birth and death registry databases in Europe. No studies have evaluated these associations in Puerto Ricans despite the fact that this group has the highest prevalence of diabetes, obesity, and major cardiometabolic risk factors among Hispanics and a population growth rate three times higher than the general US population. The proposed study provides a unique opportunity to leverage our previously-collected prospective pregnancy data from Proyecto Buena Salud (PBS, R01 DK064902, PI: Chasan-Taber). PBS was a prospective study of Puerto Rican women conducted from 2006-2011 that provided novel evidence that pregnancy complications and prenatal depression were highly prevalent in Puerto Ricans and were significantly associated with adverse maternal and birth outcomes. It has now been an average of 13.4 years since the participants’ PBS pregnancy. Our feasibility study projects that 87% (n=1,096) of PBS participants will participate in our proposed follow-up study. For the proposed study, bilingual/bicultural staff will conduct in- person visits to collect biomarkers of insulin resistance, inflammation, lipids, adiposity, blood pressure, and chronic physiological stress (hair cortisol concentrations). Interviewer-administered questionnaires, validated in Hispanics, will measure depression, psychosocial stress, and anxiety. We will use actigraphy to evaluate the novel hypothesis that poor sleep and low physical activity, highly prevalent among Puerto Ricans, may mediate the above relationships. This research is significant in prospectively assessing whether pregnancy complications offer a meaningful opportunity for early CVD prevention efforts. This research also has translational significance in informing culturally sensitive prenatal interventions for early life prevention of future chronic disorders in an understudied and particularly vulnerable population.