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Kim C, Catov J, Schreiner PJ, Appiah D, Wellons MF, Siscovick D, Calderon‐Margalit R, Huddleston H, Ebong IA, Lewis CE. Women's Reproductive Milestones and Cardiovascular Disease Risk: A Review of Reports and Opportunities From the CARDIA Study. J Am Heart Assoc 2023; 12:e028132. [PMID: 36847077 PMCID: PMC10111436 DOI: 10.1161/jaha.122.028132] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
In 1985 to 1986, the CARDIA (Coronary Artery Risk Development in Young Adults) study enrolled 5115 Black or White participants, including 2788 women, aged 18 to 30 years. Over the following 35 years, the CARDIA study amassed extensive longitudinal data on women's reproductive milestones, spanning menarche to menopause. Although not initially conceived as a study of women's health, >75 CARDIA study publications address relationships between reproductive factors and events with cardiovascular and metabolic risk factors, subclinical and clinical cardiovascular disease, and social determinants of health. The CARDIA study was one of the earliest population-based reports to note Black-White differences in age at menarche and associations with cardiovascular risk factors. Adverse pregnancy outcomes, particularly gestational diabetes and preterm birth, have been assessed along with postpartum behaviors, such as lactation. Existing studies have examined risk factors for adverse pregnancy outcomes and lactation, as well as their relationship to future cardiovascular and metabolic risk factors, diagnoses, and subclinical atherosclerosis. Ancillary studies examining components of polycystic ovary syndrome and ovarian biomarkers, such as anti-Müllerian hormone, have facilitated examination of reproductive health in a population-based cohort of young adult women. As the cohort transitioned through menopause, examination of the importance of premenopausal cardiovascular risk factors along with menopause has improved our understanding of shared mechanisms. The cohort is now aged in the 50s to mid-60s, and women will begin to experience a greater number of cardiovascular events as well as other conditions, such as cognitive impairment. Thus, in the next decade, the CARDIA study will provide a unique resource for understanding how the women's reproductive life course epidemiology informs cardiovascular risk, as well as reproductive and chronological aging.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine, Obstetrics and Gynecology, and EpidemiologyUniversity of MichiganAnn ArborMI
| | - Janet Catov
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of PittsburghPittsburghPA
| | - Pamela J. Schreiner
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMN
| | - Duke Appiah
- Department of Public Health, Graduate School of Biomedical SciencesTexas Tech UniversityLubbockTX
| | | | | | | | - Heather Huddleston
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCA
| | | | - Cora E. Lewis
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAL
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1303] [Impact Index Per Article: 1303.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Khan SS, Brewer LC, Canobbio MM, Cipolla MJ, Grobman WA, Lewey J, Michos ED, Miller EC, Perak AM, Wei GS, Gooding H. Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e76-e91. [PMID: 36780391 PMCID: PMC10080475 DOI: 10.1161/cir.0000000000001124] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.
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Axfors C, Wikström AK, Sundström Poromaa I, Hållmarker U, Michaëlsson K, Wallert J, White RA, Skalkidou A. Pre-pregnancy participation and performance in world's largest cross-country ski race as a proxy for physical exercise and fitness, and perinatal outcomes: Prospective registry-based cohort study. BJOG 2023. [PMID: 36715556 DOI: 10.1111/1471-0528.17414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/15/2022] [Accepted: 01/14/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Investigate associations between pre-pregnancy participation and performance in a demanding cross-country ski race (proxy for exercise volume and fitness) and perinatal outcomes. Pre-registered protocol: osf.io/aywg2. DESIGN Prospective cohort study. SETTING Based on entire overlap between the Vasaloppet registry and the population-based Swedish Pregnancy Register. SAMPLE All female Vasaloppet participants 1991-2017 with subsequent singleton delivery (skiers), and age- and county-matched non-skiers. METHODS We calculated odds ratios (ORs) for non-skiers versus skiers (model 1) and, among skiers, by performance (model 2), in Bayesian logistic regressions adjusted for socio-demographics, lifestyle factors, and comorbidities. We repeated calculations adjusting for early pregnancy body mass index (potential mediator) and explored robustness (selection/exposure settings; multiple comparisons correction). MAIN OUTCOME MEASURES Twenty-nine important perinatal outcomes, predefined based on existing expert consensus. RESULTS Non-skiers (n = 194 384) versus skiers (n = 15 377) (and slower versus faster performance, not shown) consistently had higher odds of gestational diabetes mellitus (GDM) (OR 1.70, 95% highest density interval: 1.40-2.09), excessive gestational weight gain (GWG) (1.28, 1.22-1.38), psychiatric morbidity (1.60, 1.49-1.72), any caesarean section (CS) (1.34, 1.28-1.40), elective CS (1.39, 1.29-1.49), and large-for-gestational-age babies (>90th percentile, 1.11, 1.04-1.18); lower odds of inadequate GWG (0.83, 0.79-0.88); and no associations with fetal/neonatal complications (e.g. preterm birth [1.09, 0.98-1.20], small for gestational age [SGA] [1.23, 1.05-1.45]). Adjustment for body mass index attenuated associations with excessive (1.20, 1.14-1.30) and inadequate GWG (0.87, 0.83-0.92) and large for gestational age (1.07, 1.00-1.13). CONCLUSION Non-skiers compared with skiers, and slower versus faster performance, consistently displayed higher odds of GDM, excessive GWG, psychiatric morbidity, CS and large-for-gestational-age babies; and lower odds of inadequate GWG, after adjustment for socio-demographic and lifestyle factors and comorbidities. There were no associations with fetal/neonatal complications.
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Affiliation(s)
- Cathrine Axfors
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Anna-Karin Wikström
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Ulf Hållmarker
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Internal Medicine, Mora Hospital, Mora, Sweden
| | - Karl Michaëlsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - John Wallert
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Huddinge, Sweden.,Stockholm Health Care Services, Stockholm, Sweden
| | - Richard A White
- Section Sykdomspulsen: Real-Time Surveillance, Norwegian Institute of Public Health, Oslo, Norway
| | - Alkistis Skalkidou
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Gadgil MD, Ingram KH, Appiah D, Rudd J, Whitaker KM, Bennett WL, Shikany JM, Jacobs DR, Lewis CE, Gunderson EP. Prepregnancy Protein Source and BCAA Intake Are Associated with Gestational Diabetes Mellitus in the CARDIA Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114142. [PMID: 36361016 PMCID: PMC9658365 DOI: 10.3390/ijerph192114142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 06/03/2023]
Abstract
Diet quality and protein source are associated with type 2 diabetes, however relationships with GDM are less clear. This study aimed to determine whether prepregnancy diet quality and protein source are associated with gestational diabetes mellitus (GDM). Participants were 1314 Black and White women without diabetes, who had at least one birth during 25 years of follow-up in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. The CARDIA A Priori Diet Quality Score (APDQS) was assessed in the overall cohort at enrollment and again at Year 7. Protein source and branched-chain amino acid (BCAA) intake were assessed only at the Year 7 exam (n = 565). Logistic regression analysis was used to determine associations between prepregnancy dietary factors and GDM. Women who developed GDM (n = 161) were more likely to have prepregnancy obesity and a family history of diabetes (p < 0.05). GDM was not associated with prepregnancy diet quality at enrollment (Year 0) (odds ratio [OR]: 1.01; 95% confidence interval [CI] 0.99, 1.02) or Year 7 (odds ratio [OR]: 0.97; 95% confidence interval [CI] 0.94, 1.00) in an adjusted model. Conversely, BCAA intake (OR:1.59, 95% CI 1.03, 2.43) and animal protein intake (OR: 1.06, 95% CI 1.02, 1.10) as a proportion of total protein intake, were associated with increased odds of GDM, while proportion of plant protein was associated with decreased odds of GDM (OR: 0.95, 95% CI 0.91, 0.99). In conclusion, GDM is strongly associated with source of prepregnancy dietary protein intake but not APDQS in the CARDIA study.
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Affiliation(s)
- Meghana D. Gadgil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Katherine H. Ingram
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center of Statistics and Analytical Sciences, Lubbock, TX 79409, USA
| | - Jessica Rudd
- Department of Statistics and Analytical Sciences, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Kara M. Whitaker
- Department of Health and Human Physiology, Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
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Zahid S, Hashem A, Minhas AS, Bennett WL, Honigberg MC, Lewey J, Davis MB, Michos ED. Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004-2019). J Am Heart Assoc 2022; 11:e026786. [PMID: 36300664 PMCID: PMC9673632 DOI: 10.1161/jaha.122.026786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Gestational diabetes (GD) is associated with increased risk of long-term cardiovascular complications. However, data on acute peripartum cardiovascular complications are not well established. Hence, we aimed to investigate the association of GD with acute cardiovascular outcomes at the time of delivery admission. Methods and Results We used data from the National Inpatient Sample (2004-2019). International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10) codes were used to identify delivery hospitalizations and GD diagnosis. A total of 63 115 002 weighted hospitalizations for deliveries were identified, of which 3.9% were among individuals with GD (n=2 435 301). The prevalence of both GD and obesity increased during the study period (P trends<0.01). Individuals with GD versus those without GD had a higher prevalence of obesity, hypertension, and dyslipidemia. After adjustment for age, race or ethnicity, comorbidities, insurance, and income, GD remained independently associated with cardiovascular complications including preeclampsia (adjusted odds ratio [aOR], 1.97 [95% CI, 1.96-1.98]), peripartum cardiomyopathy (aOR, 1.15 [1.08-1.22]), acute kidney injury (aOR, 1.16 [1.11-1.21]), stroke (aOR, 1.15 [1.09-1.23]), and arrhythmias (aOR, 1.48 [1.46-1.50]), compared with no GD. Moreover, delivery hospitalizations among individuals with GD were associated with increased length (3 versus 2 days, P<0.01) and cost of hospitalization ($4909 versus $3682, P<0.01). Even in the absence of preeclampsia, GD was associated with elevated cardiovascular risk. Conclusions Individuals with GD had a higher risk of preeclampsia, peripartum cardiomyopathy, acute kidney injury, stroke, and arrhythmias during delivery hospitalizations. As rates of GD are increasing globally, efforts to improve preconception cardiometabolic health and prevent GD may represent important strategies to improve peripartum maternal outcomes and mitigate long-term cardiovascular risk.
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Affiliation(s)
- Salman Zahid
- Sands‐Constellation Heart Institute, Rochester General HospitalRochesterNY
| | - Anas Hashem
- Sands‐Constellation Heart Institute, Rochester General HospitalRochesterNY
| | - Anum S. Minhas
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
| | - Wendy L. Bennett
- Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Michael C. Honigberg
- Cardiology Division, Department of MedicineMassachusetts General HospitalBostonMA
| | - Jennifer Lewey
- Division of Cardiology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | | | - Erin D. Michos
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
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ZAÇE DRIEDA, ORFINO ALESSIA, MARIAVITERITTI ANNA, VERSACE VALERIA, RICCIARDI WALTER, DI PIETRO MARIALUISA. A comprehensive assessment of preconception health needs and interventions regarding women of childbearing age: a systematic review. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E174-E199. [PMID: 35647378 PMCID: PMC9121675 DOI: 10.15167/2421-4248/jpmh2022.63.1.2391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
Background This systematic review summarizes the preconception health needs of women in childbearing age, necessary to be addressed to have an eventual safe and healthy pregnancy. Methods Web of Science, PubMed and Scopus were searched. We excluded studies involving women with reproductive system pathologies and referring to interconceptive or pregnancy period and non-empirical or only abstract studies. Two researchers independently performed the blind screening based on titles/abstracts and full-text and the quality assessment. Results Four major domains resulted from the thematic analysis: knowledge, behaviors and attitudes, health status and access to healthcare services. The most examined topics were knowledge and awareness on preconception health, folic acid assumption, tobacco and alcohol consumption, physical activity and healthy diet. Conclusions This review could assist healthcare professionals (physicians, nurses, midwives) in guiding tailored counselling to women to provide the adequate level of preconception care and act as a reference to policymakers.
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Affiliation(s)
- DRIEDA ZAÇE
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - ALESSIA ORFINO
- ASL Roma 2, Rome, Italy
- Correspondence: Alessia Orfino, ASL Roma 2, Rome, Italy - E-mail:
| | | | - VALERIA VERSACE
- Dipartimento di Salute della Donna e del Bambino e Sanità Pubblica - Area Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - WALTER RICCIARDI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Salute della Donna e del Bambino e Sanità Pubblica - Area Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - MARIA LUISA DI PIETRO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2499] [Impact Index Per Article: 1249.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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9
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Song Y, Wang L, Zheng D, Zeng L, Wang Y. Sleep Disturbances Before Pregnancy and Subsequent Risk of Gestational Diabetes Mellitus. Nat Sci Sleep 2022; 14:1165-1174. [PMID: 35756484 PMCID: PMC9231547 DOI: 10.2147/nss.s363792] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the relationship between sleep disturbances before pregnancy and the subsequent risk for gestational diabetes mellitus (GDM). PATIENTS AND METHODS Pregnant women who attended antenatal clinic before the 12th gestational week between September 2019 and June 2020 were enrolled. The sleep status at the month before the last menstrual period was collected by filling the Pittsburgh Sleep Quality Index (PSQI) and Berlin Questionnaire (BQ) to evaluate the sleep duration, quality and the risk of obstructive sleep apnea (OSA). With monthly antenatal care, the oral glucose tolerance test (OGTT) was performed during 24-28 gestational weeks. According to the results, GDM and non-GDM group were classified. The sleep status and baseline characters were compared between the two groups. RESULTS A total of 355 pregnant women were enrolled in this study, and 63 of them (17.7%) were diagnosed with GDM. Univariate analysis showed that maternal age, body mass index (BMI), family history of diabetes, PSQI score and positive BQ were associated with GDM (p < 0.05). Maternal age (aOR 1.10, 95% CI, 1.01-1.17), BMI before pregnancy (aOR 1.12, 95% CI, 1.02-1.23), family history of diabetes (aOR 2.35, 95% CI, 1.33-4.17), positive BQ (aOR 4.03, 95% CI, 1.04-15.63) were independent risk factors for GDM in multivariate analysis. The decision tree indicated that among the pregnant women with BMI >20.6 kg/m2 and age >28.5, the risk for GDM with positive BQ increased from 27.5% to 66.7%. CONCLUSION The high risk of OSA before pregnancy may increase the risk for GDM during pregnancy.
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Affiliation(s)
- Yifan Song
- Department of General Practice, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Liping Wang
- Department of Neurology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Danni Zheng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, People's Republic of China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, People's Republic of China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Yan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, People's Republic of China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, People's Republic of China
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10
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Li Q, Zhu Y, Wang J, Zhang Y, Pan Y, Gu R, Guo X, Wei L. Sedentary behaviors and gestational diabetes mellitus: A systematic review. J Obstet Gynaecol Res 2021; 48:285-299. [PMID: 34750937 DOI: 10.1111/jog.15090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022]
Abstract
AIM Sedentary behaviors are activities that expend less energy than 1.5 metabolic equivalents, such as watching TV, sitting. We aim to systematically review the evidence to determine the association of sedentary behavior (SB) with the risk of gestational diabetes mellitus, and the associations of SB with health outcomes in pregnant women with gestational diabetes mellitus (GDM) and women at high risk of gestational diabetes mellitus. METHODS Two researchers independently performed a literature search using PubMed, Medline, EMBASE, CINAHL, the Cochrane Library, the Rehabilitation and Sports Medicine Source, and the Sedentary Behavior Research Database for studies published up to January 27, 2021. Randomized controlled trials, quasi-experimental studies, and observational studies were screened and selected if SB was assessed in the context of gestational diabetes mellitus. Two reviewers extracted the relevant information and independently assessed the included studies for quality and bias. RESULTS Eighteen studies were included, involving 60 804 patients, and the timeline of the original study included was from 2006 to 2021. Our review showed that SB before pregnancy was not associated with the risk of gestational diabetes mellitus, while SB during pregnancy was uncertain about the risk of gestational diabetes mellitus. In addition, there were significant associations between SB time and metabolic outcomes. In addition, SB may cause some adverse maternal and fetal outcomes. CONCLUSION SB is likely to be the intermediary variable between occurrence of GDM and adverse maternal and infant outcome, rather than a direct influencing factor. Limited by the quantity and quality of included studies, the above conclusions need to be verified by more high-quality studies.
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Affiliation(s)
- Qianqian Li
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuan Zhu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jingyuan Wang
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Zhang
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yueshuai Pan
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ruting Gu
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojing Guo
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lili Wei
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3101] [Impact Index Per Article: 1033.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Dobersek U, Stallings B, Wy GC, Case CR, Maner JK. Does Exercise Make Me More Attractive? Exploring the Relations Between Exercise and Mate Value. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2020. [DOI: 10.1007/s40806-020-00270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cai C, Ruchat SM, Sivak A, Davenport MH. Prenatal Exercise and Cardiorespiratory Health and Fitness: A Meta-analysis. Med Sci Sports Exerc 2020; 52:1538-1548. [PMID: 31977635 DOI: 10.1249/mss.0000000000002279] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aimed to examine the influence of prenatal exercise on maternal cardiorespiratory health and fitness during pregnancy. METHODS Online databases were searched up to February 25, 2019. Studies of randomized controlled trials (RCTs) were eligible, which contained information on the relevant population (pregnant women), intervention (subjective or objective measures of frequency, intensity, duration, volume, or type of exercise), comparator (no exercise intervention), and outcomes (maternal cardiorespiratory fitness, including V˙O2max, submaximal V˙O2, V˙O2 at anaerobic threshold, and cardiorespiratory health, including resting heart rate, and resting systolic and diastolic blood pressures during pregnancy). RESULTS From 2699 unique citations, 26 RCTs (N = 2292 women) were included. Of these, one study reported measured V˙O2max, seven reported predicted V˙O2max, three reported submaximal V˙O2, and two studies reported VO2AT. "Low"- to "high"-certainty evidence revealed that exercise was associated with improved predicted/measured V˙O2max (5 RCTs, n = 430; mean difference [MD], 2.77 mL·kg·min; 95% confidence interval [CI], 0.32 to 5.21 mL·kg·min; I = 69%), reduced resting heart rate (9 RCTs, n = 637; MD, -1.71 bpm; 95% CI, -3.24 to -0.19 bpm; I = 13%), resting systolic blood pressure (16 RCTs, n = 1672; MD, -2.11 mm Hg; 95% CI, -3.71 to -0.51 mm Hg; I = 69%), and diastolic blood pressure (15 RCTs, n = 1624; MD, -1.77 mm Hg; 95% CI, -2.90 to -0.64 mm Hg; I = 60%). CONCLUSION Prenatal exercise interventions improve maternal predicted/measured V˙O2max and reduce resting heart rate and blood pressure. This review highlights the need for additional high-quality studies of cardiorespiratory fitness (namely, V˙O2max and V˙O2 peak) in pregnancy.PROSPERO registration number: CRD42019131249.
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Affiliation(s)
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, CANADA
| | - Allison Sivak
- H.T. Coutts Education and Physical Education Library, University of Alberta, Edmonton, Alberta, CANADA
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Wowdzia JB, Davenport MH. Cardiopulmonary exercise testing during pregnancy. Birth Defects Res 2020; 113:248-264. [PMID: 32894003 DOI: 10.1002/bdr2.1796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 12/13/2022]
Abstract
The goal of this review is to examine practical considerations when conducting cardiopulmonary exercise testing during pregnancy. In a clinical and research setting, cardiopulmonary exercise testing during pregnancy is valuable in identifying underlying cardiopulmonary conditions, stratifying the risk of adverse pregnancy outcomes, as well as establishing exercise tolerance/limitations. This review encompasses information regarding the unique physiological adaptations that occur throughout gestation (e.g., changes in resting heart rate, blood pressure, glucose, etc.) and how these adaptations impact the interpretation of physiological measurements. There are also key concerns that are unique to pregnant populations that should be considered when participating in exercise (i.e., fetus, ventilation, thermoregulation, urinary incontinence, low back pain, and pelvic girdle pain). This step-by-step review of cardiopulmonary exercise testing outlines pregnancy related adjustments to standardized methods (i.e., screening/documentation, pre- and post-test measurements, protocol specifics, modality selection, and fetal monitoring) which should be considered for the safety of both the participant and fetus. Currently, pregnancy specific exercise testing guidelines are lacking. Therefore, we will be discussing the limitations of current recommendations such as a safe cut off for resting heart rate and pregnancy specific test termination criteria.
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Affiliation(s)
- Jenna B Wowdzia
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sports and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
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Prenatal vestibular stimulation as dance (VES-D) program: A mixed methods feasibility study. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2020.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Catov JM, Sun B, Bertolet M, Snyder GG, Lewis CE, Allen NB, Shikany JM, Ingram KH, Appiah D, Gunderson EP. Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life-Course Analysis in CARDIA Women. Obesity (Silver Spring) 2020; 28:1397-1404. [PMID: 32627948 PMCID: PMC7501158 DOI: 10.1002/oby.22848] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study hypothesized that both preconception and postchildbearing patterns of cardiometabolic risk factors may be different for women with gestational diabetes mellitus (GDM) compared with women without GDM. METHODS Among 1,302 (51% black) women in the Coronary Artery Risk Development in Young Adults (CARDIA) study with births and followed for 30 years, this study evaluated changes in cardiometabolic factors (BMI, waist circumference [WC], lipids, blood pressure) during prechildbearing (prior to the first postbaseline birth) and postchildbearing periods (after the last birth) by GDM status using piecewise linear mixed models adjusted for sociodemographics, parity, and time-varying covariates. RESULTS Compared with women who did not develop GDM, weight and WC increases in women who developed GDM (n = 152, 12%) were faster (BMI difference: +0.12 kg/m2 /y, P = 0.04; WC difference: +0.28 cm/y, P = 0.04) during the prechildbearing period, accounting for covariates. This translated to an average of 1.3 kg of excess weight gain across 4 years among women with subsequent GDM versus non-GDM births. In contrast, slopes after childbearing did not differ by GDM status, nor were there other cardiometabolic differences. CONCLUSIONS Women with GDM exhibited an increasing prepregnancy pattern of weight gain and central adiposity. Absolute postchildbearing weight was also higher in GDM-affected women, but the slope of gain after GDM was not.
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Affiliation(s)
- Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences and Epidemiology, University of Pittsburgh School of Medicine and Graduate School of Public Health; Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Baiyang Sun
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marnie Bertolet
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gabrielle G. Snyder
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cora E. Lewis
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham School of Medicine; Department of Epidemiology School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Norrina B. Allen
- Department of Preventative Medicine and Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham School of Medicine; Department of Epidemiology School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katherine H. Ingram
- Kennesaw State University, Department of Exercise Science and Sport Management, Kennesaw, GA, USA
| | - Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Erica P. Gunderson
- Kaiser Permanente Northern California, Division of Research, Cardiovascular and Metabolic Conditions Section, Oakland, CA, USA
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