Ovarian Function Among Samoan Women with Obesity

项目摘要/摘要 肥胖是发展心脏代谢性疾病的一个公认的危险因素，如糖尿病和 高血压。虽然人们对肥胖对生殖健康的影响知之甚少，但在高收入人群中进行的研究 收入国家将肥胖与月经和排卵障碍以及随后的不孕症联系在一起。 这些发现对低收入和中等收入国家(LMIC)具有重大的公共卫生影响 尽管肥胖迅速增加，但获得辅助生殖治疗的机会实际上仍然不存在 流行率。与肥胖相关的发病率和死亡率在太平洋LMICs中尤其高。然而，几乎没有人 研究评估了该地区心脏代谢和生殖健康之间的关系。 以前对太平洋岛民女性月经不规律的描述依赖于 对周期长度和变异性的回溯性自我报告，这是出了名的容易受到回忆偏差和 对话者变种。到目前为止，还没有研究表明太平洋岛民女性的无排卵周期。 这很可能是因为确定排卵的黄金标准是每天进行经阴道超声检查， 一种侵入性和资源密集型的程序，对流行病学研究来说是不切实际的。 我的建议通过两个科学目标和五个培训目标来解决这些差距，这些目标利用 现有约n=150名年龄在25-39岁的萨摩亚妇女，她们的家人尼古拉·霍利博士 (赞助商)和同事自2015年以来一直在关注。这些妇女参与了健康和福祉 2015、2017/2018和2019/2020年的评估。在计划于2022年进行的第四次数据收集浪潮期间，我 将测量肥胖程度，并前瞻性地评估排卵功能。在目标1中，我将研究关联 月经不规律与当前肥胖之间的关系以及肥胖变化的纵向轨迹 萨摩亚女人。在目标2中，我将用生化方法评估有无排卵。 并探讨无排卵与体重指数之间的关系。调查结果将提供关键的 对肥胖女性继发性不孕症的洞察并为制定治疗方案提供信息 在资源匮乏的环境下评估女性的生殖潜力。此外，这个项目将揭示 太平洋岛民妇女心脏代谢和生殖风险的双重负担，尽管她们患有 在全球肥胖率最高的人群中，他们在流行病学研究中的代表性不足。 我的培训计划将使我能够发展必要的研究、临床和专业技能 成为一名内科科学家，进行纵向流行病学研究，调查 在资源匮乏的情况下，肥胖对孕产妇和儿童健康结果的影响。我的训练计划概述了课程安排， 指导研究和临床经验，以提高我在生物统计学、流行病学研究设计方面的技能 和实施以及生殖内分泌学。

PROJECT SUMMARY/ABSTRACT Obesity is a well-established risk factor for developing cardiometabolic diseases such as diabetes and hypertension. While the impact of obesity on reproductive health is less understood, studies conducted in high- income countries have associated obesity with menstrual and ovulatory dysfunction and subsequent infertility. These findings have significant public health implications for low- and middle-income countries (LMICs) where access to assisted reproduction treatment remains practically nonexistent despite rapidly increasing obesity prevalence. Obesity-related morbidity and mortality are particularly high among Pacific LMICs. However, few studies have assessed the relationship between cardiometabolic and reproductive health in this region. Previous attempts to characterize menstrual irregularity among Pacific Islander women have relied on retrospective self-report of cycle length and variability, which is notoriously subject to recall bias and interlocuter variation. No studies to date have characterized anovulatory cycles among Pacific Islander women. This is likely because the gold-standard for determining ovulation involves daily transvaginal ultrasonography, an invasive and resource-intensive procedure that is impractical for epidemiological studies. My proposal addresses these gaps through two scientific aims and five training aims that leverage an existing cohort of approximately n=150 Samoan women aged 25-39, whose families Dr. Nicola Hawley (sponsor) and colleagues have followed since 2015. These women have participated in health and wellbeing assessments in 2015, 2017/2018, and 2019/2020. During the fourth data collection wave planned for 2022, I will measure adiposity and prospectively assess ovulatory function. In Aim 1, I will examine associations between menstrual irregularity and current adiposity and longitudinal trajectories of change in adiposity among Samoan women. In Aim 2, I will biochemically evaluate the presence or absence of ovulation among regularly menstruating women and explore the association between anovulation and BMI. Findings will provide critical insight on secondary infertility among women with obesity and inform the development of protocols for evaluating female reproductive potential in low-resource settings. Moreover, this project will shed light on the dual burden of cardiometabolic and reproductive risk among Pacific Islander women, who despite having among the highest obesity prevalence globally, are underrepresented in epidemiologic research. My training plan will enable me to develop research, clinical, and professional skills necessary to become a physician-scientist who conducts longitudinal epidemiologic studies to investigate the impact of obesity on maternal and child health outcomes in low-resource settings. My training plan outlines coursework, mentored research, and clinical experiences to enhance my skills in biostatistics, epidemiological study design and implementation, and reproductive endocrinology.