Cardiovascular Health After Placental Abruption (CHAP)

摘要 胎盘早剥是一种产科并发症，定义为胎盘早剥。尽管其病因难以捉摸， 据信这是急性刺激的结果-缺血、炎症和母体胎儿的氧化应激 界面-与蜕膜动脉破裂相关，导致（过早）胎盘分离。研究 预防和孕产妇和新生儿长期心血管和出血性/血栓性脑血管事件是 这是拟议项目的核心。我们将研究预防对心血管疾病发生率的长期影响。 以及妇女及其子女的脑血管发病率和死亡率。我们还将研究 流产的临床分类（轻度和重度），基于连续妊娠流产的风险，以及 双胎妊娠中的预防措施对心血管和脑血管事件发生率的影响。我们将进行因果分析 中介分析，以评估这些关联可能通过（i）早产和 (ii)小于胎龄儿。我们将通过临床分类进行分析，并估计 在对两个测量值（社会人口特征，包括孕产妇）进行校正后， 吸烟、共病医学状况和产科事件）和未测量的混杂因素。这其中一个独特的方面是 该项目将通过支持向量机和深度学习算法的应用， 妇女的高风险预防和心脑血管死亡率和发病率。最后，我们将研究 母亲的种族/民族和社会经济地位是否是 心脑血管事件的预防和风险。我们建议通过一个大规模的 基于人群的流行病学研究，利用来自心肌梗死数据采集系统（MIDAS）的数据， 新泽西全州范围内所有非联邦急性护理医院收治的诊断为CVD的所有患者数据库， 纵向随访长达30年MIDAS数据将与NJ胎儿死亡和相关活产相关联。 1980年至2017年之间的婴儿死亡数据以及相关的孕产妇和新生儿住院数据， 在美国最大和最全面的数据库，以评估在何种程度上，在怀孕的前哨事件传授 对妇女和儿童以后的健康造成持久的风险。该项目将提供前所未有的机会， 产后妇女的公共卫生、政策影响和临床筛查建议 关于心脑血管疾病的风险易感性。

Abstract Placental abruption is an obstetrical complication defined as premature placental separation. Despite its elusive etiology, it is believed to be the consequence of acute stimuli – ischemia, inflammation, and oxidative stress at the maternal‐fetal interface – associated with rupture of the decidual artery, resulting in (premature) placental separation. The study of abruption and maternal and newborn long‐term cardiovascular and hemorrhagic/thrombotic cerebrovascular events is the central focus of the proposed project. We will examine the long‐term impact of abruption on rates of cardiovascular and cerebrovascular morbidity and mortality in women and in their children. We will also investigate the relationship of clinical classification (mild and severe forms) of abruption, risks based on abruption across successive pregnancies, and abruption in twin pregnancies, on rates of cardiovascular and cerebrovascular events. We will undertake a causal mediation analysis to evaluate the extent to which these associations may be mediated through (i) preterm delivery and (ii) small for gestational age births. We will perform this analysis by clinical classification of abruption and estimate the extent of mediation following corrections for both measured (socio‐demographic characteristics, including maternal smoking, comorbid medical conditions, and obstetrical events), and unmeasured confounding. A unique aspect of this project will be to identify, through applications of Support Vector Machines and Deep Learning algorithms, subsets of women at high risk for abruption and cardiovascular and cerebrovascular mortality and morbidity. Finally, we will examine whether maternal race/ethnicity and socioeconomic status are effect measure modifiers of the association between abruption and risks of cardiovascular and cerebrovascular events. We propose to address these aims through a large population‐based epidemiologic study, utilizing data from the Myocardial Infarction Data Acquisition System (MIDAS), a New Jersey statewide database of all patients admitted to all non‐federal acute care hospitals in NJ with a CVD diagnosis, with longitudinal follow‐up of up to 30 years. The MIDAS data will be linked to the NJ fetal death and linked live birth‐ infant death data with associated maternal and newborn hospitalization data between 1980‐2017 to create one of the largest and most comprehensive databases in the US to evaluate the extent to which sentinel events in pregnancy impart lasting risk for women's and children's health later in life. This project will provide unprecedented opportunities to address public health, policy implications and clinical screening recommendations of women during the period following delivery regarding risk susceptibility to cardiovascular and cerebrovascular disease.