Cardiovascular Risks Associated with Pregnancy in African American Women with Systemic Lupus Erythematosus

项目摘要 系统性红斑狼疮（SLE）主要影响育龄妇女。非洲 美国女性患SLE的风险是白色女性的3倍。从历史上看，患有SLE的女性 被建议不要怀孕最近，医疗建议的重点是怀孕的时间， SLE控制良好的时期。研究表明，患有SLE的女性可能有出生不良的风险 结果，但非洲裔美国妇女在这些研究中的代表性不足。此外，个人与 SLE是心血管疾病（CVD）的高危人群，不良的出生结局与晚期妊娠相关。 普通人群中的CVD。出生和妊娠结局与后期CVD健康之间的关系 在SLE女性患者中，尚未进行检查。本论文的总体目标是描述 非裔美国SLE妇女妊娠与心血管健康之间的关系在Aim中 1，我们将评估SLE与妊娠结局、早产和小胎儿之间的关系， 胎龄（SGA）在非洲裔美国妇女。在目标2中，我们将研究非洲裔美国人是否 与非裔美国人相比，分娩的SLE女性更有可能因CVD住院 从未生育的SLE患者最后，在目标3中，我们将研究非洲裔美国妇女是否 有不良分娩结局或母体并发症的SLE患者更有可能因CVD住院 与非裔美国SLE女性相比， 怀孕这项研究将使用来自格鲁吉亚狼疮登记处（GLR）和格鲁吉亚人的数据。 组织对抗狼疮（GOAL）队列。在目标1中，GLR/GOAL的女性参与者将与格鲁吉亚联系起来 出生证明，证明她们是母亲。一组出生证明的比较， 没有SLE也将被识别。早产和SGA分娩的风险将在以下妇女中进行比较： 使用对数风险回归模型。SLE临床诊断前后的风险将 考察对于目标2和3，将确定CVD住院和CVD导致的死亡， 使用关联的格鲁吉亚出院数据和死亡记录的GLR/GOAL参与者。在目标2中，我们 比较有生育史的SLE女性与无生育史的SLE女性之间CVD的风险。 使用考克斯比例风险回归模型。在目标3中，我们将比较CVD的危害 在患有SLE的分娩并对女性有不良分娩结局或母体并发症的女性中， SLE患者分娩，但没有不良的分娩结局或母体并发症，使用边缘 考克斯模特。随着SLE治疗和预期寿命的改善，估计每10万人中有200人 患有SLE的非裔美国妇女将尝试怀孕和生育。这项研究有 有可能为SLE女性患者妊娠前后的护理和管理提供信息。

Project Summary Systemic lupus erythematosus (SLE) primarily affects women during their reproductive years. African American women are at 3 times the risk of SLE compared with white women. Historically, women with SLE were advised against becoming pregnant. More recently, medical advice focuses on timing pregnancy to periods when SLE is well-controlled. Research suggests that women with SLE may be at risk of poor birth outcomes, but African American women have been underrepresented in these studies. Further, individuals with SLE are at high risk for cardiovascular disease (CVD) and adverse birth outcomes are associated with later CVD in the general population. The association between birth and pregnancy outcomes and later CVD health in women with SLE has not been examined. The overall goal of this dissertation is to characterize the associations between pregnancy and cardiovascular health among African American women with SLE. In Aim 1, we will evaluate the association between SLE and the pregnancy outcomes preterm birth and small-for- gestational age (SGA) among African American women. In Aim 2, we will examine whether African American women with SLE who gave birth are more likely to be hospitalized for CVD compared to African American women with SLE who never gave birth. Finally, in Aim 3, we will examine whether African American women with SLE who had adverse birth outcomes or maternal complications are more likely to be hospitalized for CVD compared to African American women with SLE who did not have any of these complications during pregnancy. This research will use data from both the Georgia Lupus Registry (GLR) and the Georgians Organized Against Lupus (GOAL) Cohort. In Aim 1, female participants in GLR/GOAL will be linked to Georgia birth certificates on which they are identified as the mother. A comparison set of birth certificates to women without SLE will also be identified. The risk of preterm birth and SGA birth will be compared for women with and without SLE using log-risk regression models. Risks both before and after clinical diagnosis of SLE will be examined. For Aims 2 and 3, hospitalizations for CVD and deaths attributable to CVD will be identified for GLR/GOAL participants using linked Georgia hospital discharge data and death records. In Aim 2, we will compare the hazard of CVD among women with SLE who have given birth to women with SLE who have not given birth using Cox proportional hazards regression models. In Aim 3, we will compare the hazard of CVD among women with SLE who gave birth and had adverse birth outcomes or maternal complications to women with SLE who gave birth but did not have adverse birth outcomes or maternal complications using marginal Cox models. As treatments and life expectancy for SLE improve, more of the estimated 200 per 100,000 African American women living with SLE will attempt pregnancy and childbearing. This research has the potential to contribute to informing the care and management of women with SLE before and after pregnancy.