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Sun B, Gunderson EP, Bertolet M, Lopa SH, Bryan SG, Lewis CE, Catov JM. Inflammatory, Metabolic and Endothelial Biomarkers Before and After Pregnancy Complications. Am J Epidemiol 2024:kwae053. [PMID: 38634618 DOI: 10.1093/aje/kwae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
Women with gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and preterm birth (PTB) have excess cardiovascular disease compared to those with uncomplicated births, perhaps related to pre-pregnancy inflammation, dysmetabolism or endothelial dysfunction. We included 1238 women in the Coronary Artery Risk Development in Young Adults Study (1985-2011) with 2215 births classified according to outcomes (term, uncomplicated births were the referent). Repeated measures ANOVA estimated pre-pregnancy, post-pregnancy and biomarker change according to pregnancy outcomes, adjusted for confounders. GDM and HDP groups had higher pre-pregnancy hsCRP (+0.37 [0.08, 0.65]; +0.29 [0.04, 0.55] log mg/L), leptin (+0.29 [0.09, 0.50]; +0.37 [0.17, 0.56] log ng/ml), and lower adiponectin (-0.25 [-0.36, -0.13); -0.11 [-0.22, -0.01] log ng/ml) than those with uncomplicated births and these profiles persisted in magnitude post-pregnancy. Controlling for BMI attenuated most profiles, except lower pre-pregnancy adiponectin remained associated with GDM. PTB without HDP or GDM was related to lower pre-pregnancy hsCRP and sICAM-1 (-0.31 [-0.56, -0.06] log mg/L; -0.05 [-0.09, - 0.01] log ng/ml) and a larger leptin increase from pre- to post-pregnancy, (+0.20 [0.02, 0.37] log ng/ml). Pre-pregnancy inflammation and metabolic dysfunction contributed to GDM and HDP, perhaps due to higher BMI. PTB may be related to adverse metabolic changes post-pregnancy, though the unexpected endothelial biomarker profile warrants further study.
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Gibbs BB, Kozai AC, McAdoo SN, Davis KD, Savidge MB, Paley JL, Hauspurg A, Catov JM. The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial. BMC Pregnancy Childbirth 2024; 24:261. [PMID: 38605328 PMCID: PMC11007988 DOI: 10.1186/s12884-024-06474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/31/2024] [Indexed: 04/13/2024] Open
Abstract
Pregnant individuals rarely achieve moderate-to-vigorous intensity physical activity recommendations.Purpose The sedentary behavior reduction in pregnancy intervention (SPRING) pilot and feasibility randomized trial aimed to demonstrate feasibility, acceptability, and initial efficacy of a lower intensity intervention targeting reduced sedentary behavior and increased standing and steps.Methods First trimester pregnant individuals at risk for high sedentary behavior and adverse pregnancy outcomes (APO) were randomized 2:1 to a multi-component sedentary behavior reduction intervention or no-contact control. Intervention components included biweekly remote health coaching, wearable activity monitor, height-adjustable workstation, and a private Facebook group. Evidence-based behavioral targets included sedentary time < 9 h/day, increasing standing by 2-3 h/day, and ≥ 7500 steps/day. Participants completed all-remote assessments (baseline, second trimester, third trimester) of sedentary behavior and activity (thigh-worn activPAL) along with exploratory pregnancy health outcomes abstracted from medical records. Intervention effects vs. control were evaluated using generalized mixed models and an intention-to-treat approach. Intervention participants also provided feedback on perceived benefits and acceptability.Results Participants (34 intervention; 17 control) had mean age 32 years, were 83% White, with mean pre-pregnancy BMI 28 kg/m2. Retention was high (90% and 83% at second and third trimester follow-up visits). Intervention participants decreased sedentary time (-0.84 h/day, p = 0.019) and increased standing (+0.77 h/day, p = 0.003), but did not increase steps/day (+710, p = 0.257) compared to controls. Intervention participants reported many perceived benefits and identified the wearable, height-adjustable workstation, and behavioral lessons as most useful.Conclusion For pregnant individuals at risk for high sedentary behavior and APOs, a sedentary behavior reduction intervention is feasible, acceptable, and may offer a viable alternative to more intense physical activity recommendations during pregnancy. Further testing in a fully powered clinical trial is warranted.Trial registration NCT05093842 on clinicaltrials.gov.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, PO Box 9190, 64 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Andrea C Kozai
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shannon N McAdoo
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kelliann D Davis
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Meghan B Savidge
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Joshua L Paley
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, and Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, and Magee Women's Research Institute, Pittsburgh, PA, USA
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Catov JM. Pregnancy within the context of women's health: Moving from cross-sectional to longitudinal approaches. Paediatr Perinat Epidemiol 2024; 38:180-182. [PMID: 38282380 DOI: 10.1111/ppe.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Janet M Catov
- Departments of Obstetrics and Gynecology, and Epidemiology, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Wang TL, Bryan SG, Jeyabalan A, Facco FL, Gandley RE, Hubel CA, Catov JM, Hauspurg AK. Sleep Quality in Individuals with and without Persistent Postpartum Hypertension. Am J Perinatol 2024. [PMID: 38373709 DOI: 10.1055/s-0044-1780537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE This study aimed to compare sleep quality at 1 year postpartum following a hypertensive disorder of pregnancy (HDP) among individuals with persistent postpartum hypertension (HTN) compared with those with normal blood pressures (BPs). STUDY DESIGN We combined data from the Heart Health 4 New Moms pilot randomized trial (n = 118) and the Pathways prospective cohort study (n = 36). Individuals with a singleton pregnancy complicated by gestational HTN or preeclampsia underwent a research study visit at a mean 48.7 ± 9.5 weeks postpartum with standardized BP measurement and assessment of subjective sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Persistent postpartum HTN was defined as Stage 1 HTN or greater (mean systolic BP ≥ 130 mm Hg or mean diastolic BP ≥ 80 mm Hg over three measurements at rest) or requiring antihypertensive medication. Statistical analysis was performed using univariate and multivariable logistic regression analyses. RESULTS Of 154 individuals with an HDP included in the analysis, 84 (55%) were normotensive at 1 year postpartum and 70 (45%) had persistent postpartum HTN. Individuals with persistent postpartum HTN were more likely to be older, self-identify as Black race, have higher prepregnancy and 1-year postpartum body mass index (BMI), be multiparous, and deliver at an earlier gestational age. The mean global PSQI score was 8.7 ± 3.7, with 81% reporting poor sleep (PSQI > 5), and scores were higher among individuals who were persistently hypertensive (9.6 ± 3.5) compared with those who were normotensive at 1 year postpartum (7.9 ± 3.6), p < 0.01. Findings were unchanged in a multivariable model adjusting for age, self-reported race, prepregnancy BMI, and parity. CONCLUSION Following an HDP, individuals reported poor sleep quality at 1 year postpartum. Individuals with persistent postpartum HTN reported lower sleep quality, suggesting that sleep behavior may be a target for intervention to improve maternal cardiovascular health following an HDP. KEY POINTS · After an HDP, poor sleep quality was common at 1 year postpartum.. · Those with persistent postpartum HTN reported worse sleep quality at 1 year postpartum.. · Sleep behavior may be a target for intervention to improve maternal cardiovascular health..
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Affiliation(s)
- Tiffany L Wang
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Samantha G Bryan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Arundhathi Jeyabalan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Francesca L Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Robin E Gandley
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carl A Hubel
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janet M Catov
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alisse K Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania
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Scott J, Hauspurg A, Muldoon MF, Davis EM, Catov JM. Neighborhood Deprivation, Perceived Stress, and Pregnancy-Related Hypertension Phenotypes a Decade Following Pregnancy. Am J Hypertens 2024; 37:220-229. [PMID: 37758228 PMCID: PMC10906066 DOI: 10.1093/ajh/hpad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/31/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy and other adverse pregnancy outcomes (APOs) increase the risk of developing chronic hypertension and cardiovascular disease. Perceptions of stress and neighborhood context also influence blood pressure (BP) fluctuations. We examined if APOs, higher perceived stress, and neighborhood deprivation were associated with hypertension phenotypes a decade after pregnancy in untreated individuals. METHODS Participants were 360 individuals who gave birth between 2008 and 2009 and participated in a research study 8-10 years following pregnancy. Standardized office and home BP readings were obtained, and we applied the AHA/ACC 2017 guidelines to identify sustained, white coat, and masked hypertension phenotypes. We measured personal stress with the perceived stress scale and neighborhood deprivation with the CDC Social Vulnerability Index. RESULTS Of the 38.3% (138/360) with any hypertension, 26.1% (36/138) reported a diagnosis of hypertension but were currently untreated. Sustained hypertension was the most common (17.8%), followed by masked and white coat hypertension, both 10.3%. Hypertensive disorders in pregnancy were associated with sustained (odds ratio [OR] 5.54 [95% confidence interval, CI 2.46, 12.46] and white coat phenotypes (OR 4.20 [1.66, 10.60], but not masked hypertension (OR 1.74 [0.62, 4.90]). Giving birth to a small for gestational age infant was also associated with sustained hypertension. In covariate adjusted models, perceived stress, but not neighborhood deprivation, was significantly associated with masked hypertension. CONCLUSIONS A decade after delivery, APOs were associated with sustained and white coat hypertension, but not masked hypertension. Exploration of the mechanisms underlying, and clinical implications of, these associations is warranted.
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Affiliation(s)
- Jewel Scott
- University of South Carolina College of Nursing, Columbia, South Carolina, USA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee Women’s Research Institute, Pittsburgh, Pennsylvania, USA
| | - Matthew F Muldoon
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esa M Davis
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Janet M Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Epidemiology and CTSI, University of Pittsburgh, Magee Women’s Research Institute, Pittsburgh, Pennsylvania, USA
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Paley JL, Jones MA, Catov JM, Whitaker KM, Kozai AC, Barone Gibbs B. Associations of Physical Activity and Sedentary Behaviors with Depressive Symptoms and Mood Disturbance Throughout Pregnancy. J Womens Health (Larchmt) 2024. [PMID: 38324012 DOI: 10.1089/jwh.2023.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Purpose: Mental health is critical for a healthy pregnancy, yet few studies have evaluated its associations with best practice, objectively measured moderate- to vigorous-intensity physical activity (MVPA) or sedentary behavior (SED). This study evaluated associations of MVPA and SED with mental health across pregnancy. Materials and Methods: Two cohort studies (total n = 125, mean [standard deviation] 31 [5] years, and 14.4% Black) measured MVPA (waist-worn ActiGraph GT3X) and SED (thigh-mounted activPAL) as well as self-reported depressive symptoms and mood disturbance in each trimester. Associations of group-based trajectories of MVPA and SED with depressive symptoms and mood disturbance were analyzed using regression analyses, both overall and by trimester. Results: Overall, the medium versus low trajectory of MVPA was associated with lower levels of depressive symptoms (B = -1.82, 95% confidence interval [CI] -2.97 to -0.68). In the second trimester, women in either the medium or high MVPA trajectories had lower levels of depressive symptoms compared with women in the low MVPA trajectory (B = -8.73, 95% CI -15.74 to -1.71; and B = -2.18, 95% CI -3.80 to -0.56). SED trajectories were not associated with depressive symptoms. Higher trajectories of MVPA and lower trajectories of SED were associated with lower total mood disturbance, with significant associations in the second trimester for MVPA and the first and second trimesters for SED. Higher MVPA trajectories were associated with higher tension, fatigue, and confusion subscales, while higher SED trajectories were associated with higher anger and fatigue and lower esteem and vigor subscales. Conclusions: MVPA and SED levels appear to affect mental health during pregnancy, although larger prospective studies are warranted. Clinical Trail Registration Number: NCT03084302.
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Affiliation(s)
- Joshua L Paley
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Melissa A Jones
- Department of Human Movement Science, Oakland University, Rochester, Michigan, USA
| | - Janet M Catov
- Department of Ob/Gyn and Reproductive Sciences, Magee-Womens Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kara M Whitaker
- Department of Human Movement Science, Oakland University, Rochester, Michigan, USA
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Andrea C Kozai
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown, WV, USA
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Fraser A, Catov JM. Correction: Placental syndromes and long-term risk of hypertension. J Hum Hypertens 2024; 38:88. [PMID: 37679588 PMCID: PMC10803245 DOI: 10.1038/s41371-023-00860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Abigail Fraser
- Population Health Sciences, Bristol Medical School and the MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
| | - Janet M Catov
- Department of Obstetrics, Gynaecology and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Kozai AC, Brilli Skvarca L, Parks WT, Lane A, Barone Gibbs B, Catov JM. A novel technique to estimate intravillous fetal vasculature on routine placenta histologic sections. Placenta 2024; 145:60-64. [PMID: 38071790 PMCID: PMC10842830 DOI: 10.1016/j.placenta.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/17/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Abstract
Placental histopathologic lesions are dichotomized into "present" or "absent" and have limited inter-rater reliability. Continuous metrics are needed to characterize placental health and function. Tissue sections (N = 64) of human placenta were stained with CD34 antibody and hematoxylin. Proportion of the villous space occupied by fetal vascular endothelium (%FVE; pixels positive for CD34/total pixels) was evaluated for effect sizes associated with pregnancy outcomes, smoking status, and subtypes of lesions (n = 30). Time to fixation>60 min significantly increased the quantification. Large effect sizes were found between %FVE and both preterm birth and intrauterine growth restriction. These results demonstrate proof-of-concept for this vascular estimation.
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Affiliation(s)
- Andrea C Kozai
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Lauren Brilli Skvarca
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William Tony Parks
- Department of Laboratory Medicine & Pathobiology - Anatomic Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Abbi Lane
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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Layden AJ, Bertolet M, Parks WT, Adibi JJ, Roberts JM, Catov JM. Prepregnancy obesity and risk of placental inflammation at term: a selection bias analysis. Ann Epidemiol 2023; 86:25-33.e7. [PMID: 37302673 PMCID: PMC10546767 DOI: 10.1016/j.annepidem.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE Placental histopathology is a resource for investigating obesity-associated pregnancy conditions. However, studies oversample adverse pregnancies, biasing findings. We examine the association between prepregnancy obesity (risk factor for inflammation) and histologic placental inflammation (correlated with impaired infant neurodevelopment) and how selection bias may influence the association. METHODS Singleton term deliveries between 2008 and 2012 from the Magee Obstetric Maternal and Infant database were analyzed. Prepregnancy body mass index (BMI) was categorized as underweight, lean (referent), overweight, and obese. Outcomes were diagnoses of acute (acute chorioamnionitis and fetal inflammation) and chronic placental inflammation (chronic villitis). Risk ratios for associations between BMI and placental inflammation were estimated using selection bias approaches: complete case, exclusion of pregnancy complications, multiple imputation, and inverse probability weighting. E-values approximated how susceptible estimates were to residual selection bias. RESULTS Across methods, obesity was associated with an 8-15% lower risk of acute chorioamnionitis, a 7%-14% lower risk of acute fetal inflammation, and a 12%-30% higher risk of chronic villitis relative to lean women. E-values indicated modest residual selection bias could explain away associations, though few measured indications of placental evaluations met this threshold. CONCLUSIONS Obesity may contribute to placental inflammation, and we highlight robust methods to analyze clinical data susceptible to selection bias.
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Affiliation(s)
| | - Marnie Bertolet
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA; Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, CA
| | - Jennifer J Adibi
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - James M Roberts
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
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Scott J, Hauspurg A, Davis EM, Bryan S, Catov JM. Maternal Mental Health, COVID-19-Related Distress, and Disruptions in Lifestyle Behaviors Among Postpartum Mothers With a Previous Hypertensive Disorder of Pregnancy. J Cardiovasc Nurs 2023:00005082-990000000-00126. [PMID: 37723619 PMCID: PMC10948378 DOI: 10.1097/jcn.0000000000001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND Many perinatal people experienced pandemic-related distress and changes in health behaviors at the onset of the COVID-19 pandemic, but less is known about how the pandemic continued to impact their health. OBJECTIVE The authors of this study examined the influence of pandemic-related distress and maternal mental health on postpartum lifestyle behaviors of mothers with a previous hypertensive disorder of pregnancy. METHODS Between September 2021 and March 2022, 82 postpartum (19.2 ± 5.5 months) mothers with a hypertensive disorder of pregnancy completed measures of pandemic-related distress and pandemic-related disruption in lifestyle behaviors from the Coronavirus Perinatal Experiences Impact Survey. A Patient Health Questionnaire-9 score ≥ 10 and a score ≥ 3 on the Breslau scale indicated significant depressive and posttraumatic stress disorder (PTSD) symptoms, respectively. RESULTS Twenty-two (27.2%) and 30 (36.6%) participants had significant depressive or PTSD symptoms, respectively. In models adjusted for education, income, parity, delivery prepandemic or peripandemic, intervention group, and prepregnancy mental health history, both PTSD symptoms (B = 0.229, P = .029) and pandemic-related distress (B = 0.492, P < .001) associated with greater disruption in health behaviors. Depressive symptoms did not associate with greater disruption in health behaviors (B = 0.169, P = .135). CONCLUSION Monitoring PTSD symptoms may be vital in supporting mothers with hypertensive disorders of pregnancy in making lifestyle changes to prevent cardiovascular disease.
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Theilen LH, McNeil RB, Hunter S, Grobman WA, Parker CB, Catov JM, Pemberton VL, Ehrenthal DB, Haas DM, Hoffman MK, Chung JH, Mukhtar F, Arzumanyan Z, Mercer B, Parry S, Saade GR, Simhan HN, Wapner RJ, Silver RM. Serum Cotinine and Adverse Cardiovascular Outcomes: A Cross-sectional Secondary Analysis of the nuMoM2b Heart Health Study. Am J Perinatol 2023; 40:1311-1320. [PMID: 34359079 PMCID: PMC8818058 DOI: 10.1055/a-1580-3155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We aimed to (1) compare serum cotinine with self-report for ascertaining smoking status among reproductive-aged women; (2) estimate the relative odds of adverse cardiovascular (CV) outcomes among women by smoking status; (3) assess whether the association between adverse pregnancy outcomes (APOs) and CV outcomes varies by smoking status. STUDY DESIGN We conducted a cross-sectional study of the nuMoM2b Heart Health Study. Women attended a study visit 2 to 7 years after their first pregnancy. The exposure was smoking status, determined by self-report and by serum cotinine. Outcomes included incident chronic hypertension (HTN), metabolic syndrome (MetS), and dyslipidemia. Multivariable logistic regression estimated odds ratios (ORs) for each outcome by smoking status. RESULTS Of 4,392 women with serum cotinine measured, 3,610 were categorized as nonsmokers, 62 as secondhand smoke exposure, and 720 as smokers. Of 3,144 women who denied tobacco smoke exposure, serum cotinine was consistent with secondhand smoke exposure in 48 (1.5%) and current smoking in 131 (4.2%) After adjustment for APOs, smoking defined by serum cotinine was associated with MetS (adjusted OR [aOR] = 1.52, 95% confidence interval [CI]: 1.21, 1.91) and dyslipidemia (aOR = 1.28, 95% CI: 1.01, 1.62). When stratified by nicotine exposure, nonsmokers with an APO in their index pregnancy had higher odds of stage 1 (aOR = 1.64, 95% CI: 1.32, 2.03) and stage 2 HTN (aOR = 2.92, 95% CI: 2.17, 3.93), MetS (aOR = 1.76, 95% CI: 1.42, 2.18), and dyslipidemia (aOR = 1.55, 95% CI: 1.25, 1.91) relative to women with no APO. Results were similar when smoking exposure was defined by self-report. CONCLUSION Whether determined by serum cotinine or self-report, smoking is associated with subsequent CV outcomes in reproductive-aged women. APOs are also independently associated with CV outcomes in women. KEY POINTS · Cotinine was detected in 5.7% of reported nonsmokers.. · Smoking and APOs were independently associated with CV health.. · Smoking was associated with MetS and dyslipidemia..
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Affiliation(s)
- Lauren H. Theilen
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Rebecca B. McNeil
- Division of Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina
| | - Shannon Hunter
- Division of Biostatistics, RTI International, Research Triangle Park, North Carolina
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Corette B. Parker
- Division of Biostatistics, RTI International, Research Triangle Park, North Carolina
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburg, Pittsburg, Pennsylvania
| | - Victoria L. Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLB), Bethesda, Maryland
| | - Deborah B. Ehrenthal
- Department of Obstetrics and Gynecology, School of Medicine, University of Wisconsin, Madison, Wisconsin
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care, Wilmington, Delaware
| | - Judith H. Chung
- Department of Obstetrics and Gynecology, School of Medicine, University of California-Irvine, Irvine, California
| | - Farhana Mukhtar
- Department of Obstetrics and Gynecology, School of Medicine, University of California-Irvine, Irvine, California
| | - Zorayr Arzumanyan
- Department of Biomedical Research, The Lundquist Institute, Los Angeles, California
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio
| | - Samuel Parry
- Department of Maternal Fetal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - George R. Saade
- Division Chief of Maternal Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
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Fraser A, Catov JM. Placental syndromes and long-term risk of hypertension. J Hum Hypertens 2023; 37:671-674. [PMID: 36702879 PMCID: PMC10403351 DOI: 10.1038/s41371-023-00802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/28/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
Higher blood pressure prior to pregnancy is associated with increased risk of placental abruption, hypertension and preeclampsia, preterm delivery and fetal growth restriction. These conditions are jointly termed placental syndromes as they are characterised by impaired placentation and early placental vascularization. Placental syndromes are associated with an increased maternal risk of progression to hypertension and cardiovascular disease (CVD) in later life. Women affected by both a clinical placental syndrome and with evidence of placental maternal vascular malperfusion (MVM) have a particularly high risk of hypertension and CVD. Yet whether placental impairment and clinical syndromes are causes or consequences of higher blood pressure in women remains unclear. In this review, we address the relationship between blood pressure and maternal health in pregnancy. We conclude that there is a pressing need for studies with a range of detailed measures of cardiac and vascular structure and function taken before, during and after pregnancy to solve the 'chicken and egg' puzzle of women's blood pressure and pregnancy health, and to inform effective precision medicine prevention and treatment of both placental syndromes and chronic hypertension in women.
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Affiliation(s)
- Abigail Fraser
- Population Health Sciences, Bristol Medical School and the MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
| | - Janet M Catov
- Department of Obstetrics, Gynaecology and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Ibarra AJ, Butters MA, Lim G, Jeyabalan A, Li R, Balasubramani GK, Catov JM. Longitudinal cognitive evaluation before and after delivery among people with preeclampsia. Am J Obstet Gynecol MFM 2023; 5:100966. [PMID: 37084869 PMCID: PMC10876122 DOI: 10.1016/j.ajogmf.2023.100966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Cognitive impairments related to preeclampsia after pregnancy have been reported; however, it is not known if weaknesses in cognition occur before and shortly after delivery. OBJECTIVE This study aimed to assess the feasibility of longitudinal cognitive testing before and after delivery, and to investigate whether those with preeclampsia have cognitive weaknesses during the third trimester of pregnancy and at 1 and 3 months postpartum. We hypothesized that people with preeclampsia would have lower cognition scores across all time points compared with normotensive people. STUDY DESIGN This longitudinal, prospective, observational study in a single institution enrolled people (N=30) at ≥28 weeks of gestation with preeclampsia (N=16) or normotension (N=14). People with chronic hypertension, neurologic or developmental disabilities, moderate or severe depression or anxiety, or current substance use were excluded. Subjective (Everyday Cognition Scale) and objective assessment of executive function (Stroop Color-Word Interference Test, Trail-Making Test), attention and working memory (Digit Span subtest), and information processing speed (Digit Symbol Substitution Test) was conducted, and Z-scores were calculated. Baseline characteristics (eg, prepregnancy body mass index) were collected from the medical record. Generalized linear models were used to estimate associations. RESULTS We enrolled 37% (30/81) of eligible people and retained 80% (24/30) and 53% (16/30) at 1 and 3 months postpartum, respectively. People with preeclampsia reported more memory problems (ß=0.87; 95% confidence interval, 0.44-1.31), and scored worse on attention and working memory (ß=-0.94; 95% confidence interval, -1.42 to -0.45) and executive function (Stroop test ß=-0.86; 95% confidence interval, -1.53 to -0.19) domains compared with normotensive people after adjusting for time, age, education, and prepregnancy body mass index. CONCLUSION Longitudinal assessment of cognition in pregnant preeclamptic and normotensive people is feasible. People with preeclampsia reported worse subjective memory and had lower scores in attention, working memory, and executive function.
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Affiliation(s)
- Andrea J Ibarra
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim).
| | | | - Grace Lim
- Departments of Anesthesiology and Perioperative Medicine (Drs Ibarra and Lim)
| | - Arun Jeyabalan
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA
| | - Runjia Li
- Departments of Epidemiology (Ms Li and Dr Catov)
| | | | - Janet M Catov
- Obstetrics, Gynecology and Reproductive Sciences (Drs Jeyabalan and Catov), University of Pittsburgh, Pittsburgh, PA; Departments of Epidemiology (Ms Li and Dr Catov); Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Dr Catov)
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14
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Countouris ME, Koczo A, Reynolds HR, Hausvater A, Mann H, Wang Y, Sharbaugh D, Thoma FW, Mulukutla SR, Catov JM. Characteristics of Premature Myocardial Infarction Among Women With Prior Adverse Pregnancy Outcomes. JACC Adv 2023; 2:100411. [PMID: 37694271 PMCID: PMC10487279 DOI: 10.1016/j.jacadv.2023.100411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Adverse pregnancy outcomes (APOs), hypertensive disorders of pregnancy, gestational diabetes mellitus, and preterm birth are associated with ischemic heart disease in later life. OBJECTIVES The authors aimed to study the features of premature myocardial infarction (MI) among women with and without prior APOs. METHODS We performed a retrospective analysis of women with premature MI (<65 years of age) referred for left heart catheterization matched with a database of abstracted pregnancy data. We compared MI characteristics and epicardial coronary anatomy between women with and without APOs during their index pregnancy and evaluated time from delivery to MI. RESULTS Of 391 women with premature MI and associated coronary angiography (age: 49 ± 8 years), 154 (39%) had a prior APO (hypertensive disorders of pregnancy n = 78, preeclampsia n = 35, gestational diabetes mellitus n = 28, and preterm birth n = 48). Women with APO history had a higher prevalence of diabetes (33% vs 16% without APO; P = 0.001) and presented earlier with MI following delivery (19.6 [IQR: 14.3-23.5] years vs those without APO 21.5 [IQR: 17.0-25.4] years; P = 0.012), driven by preeclampsia (17.1 [IQR: 12.7-22.4] years, P = 0.010). Women with and without APOs had similar MI features including rates of ST-segment elevation MI, obstructive and multi-vessel coronary artery disease, percutaneous coronary intervention, and shock. CONCLUSIONS Among women with premature MIs, 39% had a history of an APO. Women with APO history presented sooner after pregnancy but had similar MI characteristics vs those without APOs. Pregnancy history may identify women who warrant early, aggressive cardiovascular disease prevention.
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Affiliation(s)
- Malamo E. Countouris
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Agnes Koczo
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Harmony R. Reynolds
- Leon H. Charney Division of Cardiology, Department of Medicine, Sarah Ross Soter Center for Women’s Cardiovascular Research, NYU Grossman School of Medicine, New York, New York, USA
| | - Anais Hausvater
- Leon H. Charney Division of Cardiology, Department of Medicine, Sarah Ross Soter Center for Women’s Cardiovascular Research, NYU Grossman School of Medicine, New York, New York, USA
| | - Harnoor Mann
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Danielle Sharbaugh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Floyd W. Thoma
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Suresh R. Mulukutla
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Janet M. Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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15
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Barone Gibbs B, Kozai AC, McAdoo SN, Bastyr MC, Davis KD, Hauspurg A, Catov JM. Rationale, Design, and Methods for the Sedentary Behavior Reduction in Pregnancy Intervention (SPRING): Protocol for a Pilot and Feasibility Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48228. [PMID: 37314845 DOI: 10.2196/48228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Adverse pregnancy outcomes (APOs) identify cardiovascular disease risk, but few effective interventions are available. High sedentary behavior (SED) has recently been associated with APOs, but very few randomized controlled trials (RCTs) have tested SED reduction in pregnancy. OBJECTIVE The Sedentary Behavior Reduction in Pregnancy Intervention (SPRING) pilot and feasibility RCT addresses this gap by testing the feasibility, acceptability, and preliminary pregnancy health effects of an intervention to reduce SED in pregnant women. The objective of this manuscript is to describe the rationale and design of SPRING. METHODS Pregnant participants (n=53) in their first trimester, who are at risk for high SED and APO and without contraindications, are randomized in a 2:1 ratio to an intervention or control group. SED (primary outcome) and standing durations, and steps per day, are measured objectively in each trimester for 1 week with a thigh-mounted activPAL3 accelerometer. SPRING also seeks to demonstrate feasibility and acceptability while estimating preliminary effects on maternal-fetal health outcomes assessed during study visits and abstracted from medical records. The pregnancy-customized intervention promotes daily behavioral targets of less than 9 hours of SED and at least 7500 steps, achieved via increased standing and incorporating light-intensity movement breaks each hour. The multicomponent intervention provides a height-adjustable workstation, a wearable activity monitor, behavioral counseling every 2 weeks (through videoconference), and membership in a private social media group. Herein, we review the rationale, describe recruitment and screening processes, and detail the intervention, assessment protocols, and planned statistical analyses. RESULTS This study was funded by the American Heart Association (20TPA3549099), with a funding period of January 1, 2021, and until December 31, 2023. Institutional review board approval was obtained on February 24, 2021. Participants were randomized between October 2021 and September 2022, with final data collection planned for May 2023. Analyses and submission of results are expected for winter of 2023. CONCLUSIONS The SPRING RCT will provide initial evidence on the feasibility and acceptability of an SED-reduction intervention to decrease SED in pregnant women. These data will inform the design of a large clinical trial testing SED reduction as a strategy to reduce APO risk. TRIAL REGISTRATION ClincialTrials.gov NCT05093842; https://clinicaltrials.gov/ct2/show/NCT05093842. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48228.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown, WV, United States
| | - Andrea C Kozai
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shannon N McAdoo
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meghan C Bastyr
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Kelliann D Davis
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alisse Hauspurg
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, United States
- Magee-Womens Research Institute, Pittsburgh, PA, United States
| | - Janet M Catov
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, United States
- Magee-Womens Research Institute, Pittsburgh, PA, United States
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16
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Magnus MC, Wallace MK, Demirci JR, Catov JM, Schmella MJ, Fraser A. Breastfeeding and Later-Life Cardiometabolic Health in Women With and Without Hypertensive Disorders of Pregnancy. J Am Heart Assoc 2023; 12:e026696. [PMID: 36847057 PMCID: PMC10111449 DOI: 10.1161/jaha.122.026696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Breastfeeding is associated with improved cardiometabolic profiles decades after pregnancy. Whether this association exists for women who experience hypertensive disorders of pregnancy (HDP) is unknown. The authors examined whether breastfeeding duration or exclusivity are associated with long-term cardiometabolic health, and whether this relationship differs by HDP status. Methods and Results Participants (N=3598) were from the UK ALSPAC (Avon Longitudinal Study of Parents and Children) cohort. HDP status was assessed by medical record review. Breastfeeding behaviors were assessed by contemporaneous questionnaires. Breastfeeding duration was categorized as never, <1, 1 to <3, 3 to <6, 6 to <9, and 9+ months. Breastfeeding exclusivity was categorized as never, <1, 1 to <3, and 3 to 6 months. Measures of cardiometabolic health (body mass index, waist circumference, C-reactive protein, insulin, proinsulin, glucose, lipids, blood pressure, mean arterial pressure, carotid intima-media thickness, and arterial distensibility) were measured 18 years after pregnancy. Analyses were conducted using linear regression adjusting for relevant covariates. Breastfeeding was associated with improved cardiometabolic health (lower body mass index, waist circumference, C-reactive protein, triglycerides, insulin, and proinsulin) in all women, but not for every breastfeeding duration. Interaction tests revealed additional benefits in women with a history of HDP, with the strongest benefit observed in the 6- to 9-month breastfeeding category (diastolic blood pressure, -4.87 mm Hg [95% CI, -7.86 to -1.88], mean arterial pressure -4.61 [95% CI, -7.45 to -1.77], and low-density lipoprotein cholesterol, -0.40 mmol/L [95% CI, -0.62 to -0.17 mmol/L]). Differences in C-reactive protein and low-density lipoprotein "survived" Bonferroni correction (P<0.001). Similar results were observed in the exclusive breastfeeding analyses. Conclusions Breastfeeding may be a mechanism to reduce the cardiovascular disease sequela associated with HDP; however, there is a need to establish whether associations reflect a causal effect.
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Affiliation(s)
- Maria C Magnus
- Center for Fertility and Health Norwegian Institute of Public Health Oslo Norway.,MRC Integrative Epidemiology Unit at the University of Bristol Bristol United Kingdom.,Population Health Sciences Bristol Medical School Bristol United Kingdom
| | - McKenzie K Wallace
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing The Ohio State University Columbus OH
| | - Jill R Demirci
- School of Nursing University of Pittsburgh Pittsburgh PA
| | - Janet M Catov
- Department of Epidemiology University of Pittsburgh Pittsburgh PA.,Department of Obstetrics, Gynecology & Reproductive Science University of Pittsburgh Pittsburgh PA
| | | | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol Bristol United Kingdom.,Population Health Sciences Bristol Medical School Bristol United Kingdom
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17
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Barha CK, Best JR, Rosano C, Yaffe K, Catov JM, Liu-Ambrose T. Walking for Cognitive Health: Previous Parity Moderates the Relationship Between Self-Reported Walking and Cognition. J Gerontol A Biol Sci Med Sci 2023; 78:486-493. [PMID: 35670837 PMCID: PMC9977231 DOI: 10.1093/gerona/glac123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Older females show greater cognitive gains from physical activity (PA) than males, which may be related to long-term consequences of female-specific reproductive events (eg, pregnancy) on cognitive health. METHODS To determine whether previous parity could moderate the relationship between PA and cognitive decline in older women, we conducted secondary analyses of data from the Health, Aging, and Body Composition Study. We tested whether the association between average PA over 10 years and cognition (Modified Mini-Mental State Examination [3MS]) and executive functioning (digit symbol substitution test [DSST]) over 10 years varied by previous parity (nulliparity, low parity, medium parity, and grand multiparity). An analysis of covariance was performed with cognition (average and change over 10 years) as the dependent variables, parity as a categorical predictor, average PA as a continuous predictor, and a set of relevant covariates. RESULTS Significant interactions were found between PA and parity group for all 4 comparisons: average 3MS (p = .014), average DSST (p = .032), change in 3MS (p = .016), and change in DSST (p = .017). Simple slope analyses indicated the positive relationship between PA and average 3MS and DSST was only significant in the nulliparity and grand multiparity groups, and the positive relationship between PA and change in 3MS and DSST was only significant in the grand multiparity group. CONCLUSION The findings suggest the relationship between self-reported walking and cognitive performance was strongest in the groups at risk for cognitive decline and dementia, the nulliparous and grand multiparous groups.
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Affiliation(s)
- Cindy K Barha
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - John R Best
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, California, San Francisco, USA
- Departments of Psychiatry and Neurology, University of California, San Francisco, California,USA
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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18
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Barone Gibbs B, Kozai A, McAdoo S, Paley J, Hauspurg A, Davis K, Catov JM. Abstract P242: Accuracy of a Self-Report Screening Tool for Identifying Pregnant People With High Sedentary Behavior. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Introduction:
High levels of sedentary behavior (SB) are emerging as a distinct risk factor in pregnancy for poor maternal-fetal health outcomes. Thigh-worn accelerometry is ideal for quantifying SB but has high cost and participant burden; simple screening questions that could quickly identify those with high SB in clinical or research settings are desirable. We aimed to evaluate the accuracy of self-report screening questions for identifying pregnant participants with high SB.
Methods:
This secondary analysis used baseline data from the
S
edentary Behavior Reduction in
Pr
egnancy
In
tervention (SPRING) feasibility trial. During eligibility screening, participants in their first trimester met at least one of four study-developed, self-reported criteria that put them at risk for high SB: 1) mostly sitting job ≥ 30 h/week; 2) mostly sitting job <30 h/week and reporting sitting ≥ ½ of non-work time; 3) did not work but reported sitting ≥ ¾ of time; and 4) <6,000 steps/d from a wearable device. Eligible participants then underwent baseline SB assessment using a thigh-worn accelerometer (activPAL3, 7 d x 24 h). The proportion of participants meeting evidence-based definitions for high SB were calculated for each criterion. Definitions of high SB included: SB > 10 h/d (+10h), SB > 66.7% of waking time (+66.7%), and < 6,000 steps per day (low steps).
Results:
Participants (n=51) enrolled in the study with mean (SD) age=32 (4) years, 82% White, and 84% with a college degree or greater. Of these, n=50 had valid objective SB data at baseline. On average, participants met high SB definitions with mean (SD) SB of 10.5 (1.5) hours per day, 77% (11%) of waking time in SB, and with 5,646 (2,954) steps per day. Among those with a mostly sitting job ≥ 30 h/week (n=33), 66% were above the +10h definition, 71% met the +66.7% definition, and 57% met the low steps definition. For participants with a mostly sitting but <30 h/week job (n=7) and high sitting otherwise, 57% met the +10h definition, 100% met the +66.7% definition, and 71% met the low steps definition. Participants who did not work and reported ¾ time in SB (n=5) met each definition 80% of the time. Participants who reported <6000 steps per day from a wearable (n=3) met all definitions 66.7% of the time. Those below the +10h SB threshold had mean (range) SB of 8.7 (7.5 to 9.4) h/d, those below the +67% SB threshold were sedentary 57.9% (51.1% to 61.3%) of the time, and those above the low steps threshold had 9,478 (6023 to 14,751) steps per day.
Conclusions:
Screening questions mostly identified participants who were highly sedentary, though approximately one in three did not meet thresholds for objectively-measured high SB. Future research refining screening questions is needed to improve the accuracy of identifying pregnant people with high SB by self-report, who may be at higher risk of adverse pregnancy outcomes.
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Lugobe HM, Kayondo M, Mceniery CM, Catov JM, Wilkinson IB, Wylie BJ, Vaught AJ, Muhindo R, Boatin AA. Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda. AJOG Glob Rep 2023; 3:100163. [PMID: 36860930 PMCID: PMC9969249 DOI: 10.1016/j.xagr.2023.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Hypertension is a key contributor to the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor. Hypertensive disorders of pregnancy, of which preeclampsia and eclampsia are the most common forms, have been shown to be a female-specific risk factor for chronic hypertension. OBJECTIVE This study aimed to determine the proportion and risk factors for persistent hypertension at 3 months after delivery among women with hypertensive disorders of pregnancy in Southwestern Uganda. STUDY DESIGN This was a prospective cohort study of pregnant women with hypertensive disorders of pregnancy admitted for delivery at Mbarara Regional Referral Hospital in Southwestern Uganda from January 2019 to December 2019; however, women with chronic hypertension were excluded from the study. The participants were followed up for 3 months after delivery. Participants with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg or receiving antihypertension therapy at 3 months after delivery were considered to have persistent hypertension. Multivariable logistic regression was used to determine independent risk factors associated with persistent hypertension. RESULTS A total of 111 participants with hypertensive disorders of pregnancy diagnosed at hospital admission were enrolled with a follow-up rate of 49% (54/111) at 3 months after delivery. Of these women, 21 of 54 (39%) had persistent hypertension 3 months after delivery. In the adjusted analyses, an elevated serum creatinine level (>106.08 µmol/L [≤1.2 mg/dL]) at admission for delivery was the only independent risk factor for persistent hypertension at 3 months after delivery (adjusted relative risk, 1.93; 95% confidence interval, 1.08-3.46; P=.03), controlling for age, gravidity, and eclampsia. CONCLUSION Approximately 4 of 10 women presenting with hypertensive disorders of pregnancy at our institution remained hypertensive 3 months after delivery. Innovative strategies are needed to identify these women and provide long-term care to optimize blood pressure control and reduce future cardiovascular disease after hypertensive disorders of pregnancy.
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Affiliation(s)
- Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda (Drs Lugobe and Kayondo),Department of Medicine, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (Drs Lugobe, Mceniery, and Wilkinson),Corresponding author: Henry Mark Lugobe, MD.
| | - Musa Kayondo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda (Drs Lugobe and Kayondo)
| | - Carmel M. Mceniery
- Department of Medicine, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (Drs Lugobe, Mceniery, and Wilkinson)
| | - Janet M. Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA (Dr Catov)
| | - Ian B. Wilkinson
- Department of Medicine, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (Drs Lugobe, Mceniery, and Wilkinson)
| | - Blair J. Wylie
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY (Dr Wylie)
| | - Arthur J. Vaught
- Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD (Dr Vaught)
| | - Rose Muhindo
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda (Dr Muhindo)
| | - Adeline A. Boatin
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston MA (Dr Boatin)
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Hauspurg A, Hart R, Wang T, Bryan S, Jeyabalan A, Catov JM. Blood pressure trajectories through pregnancy and first year postpartum following a hypertensive disorder of pregnancy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Ray M, McNeil RB, Grobman WA, Catov JM, Schmella MJ, Conley YP. First-trimester allostatic load varies by self-identified race/ethnicity and HDP. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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22
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Sutherland L, Hart R, Bryan S, Jeyabalan A, Catov JM, Hauspurg A. Postpartum perception of cardiovascular risk and risk modification in patients with hypertensive disorders of pregnancy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Makarem N, Chau K, Miller EC, Gyamfi-Bannerman C, Tous I, Booker W, Catov JM, Haas DM, Grobman WA, Levine LD, McNeil R, Bairey Merz CN, Reddy U, Wapner RJ, Wong MS, Bello NA. Association of a Mediterranean Diet Pattern With Adverse Pregnancy Outcomes Among US Women. JAMA Netw Open 2022; 5:e2248165. [PMID: 36547978 PMCID: PMC9857221 DOI: 10.1001/jamanetworkopen.2022.48165] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/06/2022] [Indexed: 12/24/2022] Open
Abstract
Importance The Mediterranean diet pattern is inversely associated with the leading causes of morbidity and mortality, including metabolic diseases and cardiovascular disease, but there are limited data on its association with adverse pregnancy outcomes (APOs) among US women. Objective To evaluate whether concordance to a Mediterranean diet pattern around the time of conception is associated with lower risk of developing any APO and individual APOs. Design, Setting, and Participants This prospective, multicenter, cohort study, the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be, enrolled 10 038 women between October 1, 2010, and September 30, 2013, with a final analytic sample of 7798 racially, ethnically, and geographically diverse women with singleton pregnancies who had complete diet data. Data analyses were completed between June 3, 2021, and April 7, 2022. Exposures An Alternate Mediterranean Diet (aMed) score (range, 0-9; low, 0-3; moderate, 4-5; and high, 6-9) was computed from data on habitual diet in the 3 months around conception, assessed using a semiquantitative food frequency questionnaire. Main Outcomes and Measures Adverse pregnancy outcomes were prospectively ascertained and defined as developing 1 or more of the following: preeclampsia or eclampsia, gestational hypertension, gestational diabetes, preterm birth, delivery of a small-for-gestational-age infant, or stillbirth. Results Of 7798 participants (mean [SD] age, 27.4 [5.5] years), 754 (9.7%) were aged 35 years or older, 816 (10.5%) were non-Hispanic Black, 1294 (16.6%) were Hispanic, and 1522 (19.5%) had obesity at baseline. The mean (SD) aMed score was 4.3 (2.1), and the prevalence of high, moderate, and low concordance to a Mediterranean diet pattern around the time of conception was 30.6% (n=2388), 31.2% (n=2430), and 38.2% (n=2980), respectively. In multivariable models, a high vs low aMed score was associated with 21% lower odds of any APO (adjusted odds ratio [aOR], 0.79 [95% CI, 0.68-0.92]), 28% lower odds of preeclampsia or eclampsia (aOR, 0.72 [95% CI, 0.55-0.93]), and 37% lower odds of gestational diabetes (aOR, 0.63 [95% CI, 0.44-0.90]). There were no differences by race, ethnicity, and prepregnancy body mass index, but associations were stronger among women aged 35 years or older (aOR, 0.54 [95% CI, 0.34-0.84]; P = .02 for interaction). When aMed score quintiles were evaluated, similar associations were observed, with higher scores being inversely associated with the incidence of any APO. Conclusions and Relevance This cohort study suggests that greater adherence to a Mediterranean diet pattern is associated with lower risk of APOs, with evidence of a dose-response association. Intervention studies are needed to assess whether dietary modification around the time of conception can reduce risk of APOs and their downstream associations with future development of cardiovascular disease risk factors and overt disease.
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Affiliation(s)
- Nour Makarem
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Kristi Chau
- Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Eliza C. Miller
- Department of Neurology, Columbia University Irving Medical Center, New York, New York
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, School of Medicine, San Diego
| | - Isabella Tous
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Whitney Booker
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Janet M. Catov
- Magee Women’s Research Institute, Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David M. Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | | | - Lisa D. Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rebecca McNeil
- RTI International, Research Triangle Park, North Carolina
| | | | - Uma Reddy
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Melissa S. Wong
- Department of Obstetrics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Natalie A. Bello
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Beussink-Nelson L, Baldridge AS, Hibler E, Bello NA, Epps K, Cameron KA, Lloyd-Jones DM, Gooding HC, Catov JM, Rich-Edwards JW, Yee LM, Toledo P, Banayan JM, Khan SS. Knowledge and perception of cardiovascular disease risk in women of reproductive age. Am J Prev Cardiol 2022; 11:100364. [PMID: 35866048 PMCID: PMC9294042 DOI: 10.1016/j.ajpc.2022.100364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/19/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in American women, but general knowledge and perception of risk in this population remains poor. In this cross-sectional study of young women, significant gaps in knowledge and perception of CVD risk in individuals who have experienced an APO were identified along with general knowledge deficits related to pregnancy-related risk factors and CVD risk in young women. These findings provide primary data to support the need for development and delivery of educational content on CVD risk to young women, particularly during the peripartum period.
Objective Women who experience adverse pregnancy outcomes (APO) are at increased risk for cardiovascular disease (CVD); however, their knowledge of CVD risk is not well characterized. We aimed to evaluate knowledge and perception of CVD risk in young women and to determine whether these factors differ based on experience of an APO. Methods We conducted a cross-sectional study among women with a recent live birth at an urban medical center. Knowledge and perception of CVD risk were assessed through a self-administered online survey adapted from the American Heart Association Survey of Women's CVD Awareness. Results Of 5612 individuals contacted between 3/1/21 and 4/18/21, 714 completed the survey; the mean (SD) age was 34 (4) years and 25% reported an APO. While 62% of respondents identified CVD as the leading cause of death in women, there was no significant difference in CVD knowledge scores between participants who reported experiencing an APO and those who did not (6.9 vs 6.8 out of 10; p = 0.51). Participants who reported experiencing an APO had higher perception of personal risk for CVD (adjusted odds ratio, 2.64 [95% CI 1.83-3.80]) compared with participants who did not. Half of participants who experienced an APO reported perceiving average, or below average, risk for CVD and only 41 (22.5%) reported speaking with a healthcare professional about CVD within the past year. Conclusions Gaps remain in knowledge of CVD risk among young women, particularly after an APO. The peripartum period may represent a unique opportunity for targeted education when healthcare engagement is high.
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Cameron NA, Petito LC, Shah NS, Perak AM, Catov JM, Bello NA, Capewell S, O’Flaherty M, Lloyd-Jones DM, Greenland P, Grobman WA, Khan SS. Association of Birth Year of Pregnant Individuals With Trends in Hypertensive Disorders of Pregnancy in the United States, 1995-2019. JAMA Netw Open 2022; 5:e2228093. [PMID: 36001318 PMCID: PMC9403773 DOI: 10.1001/jamanetworkopen.2022.28093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Hypertensive disorders of pregnancy are leading causes of morbidity and mortality among pregnant individuals as well as newborns, with increasing incidence during the past decade. Understanding the individual associations of advancing age of pregnant individuals at delivery, more recent delivery year (period), and more recent birth year of pregnant individuals (cohort) with adverse trends in hypertensive disorders of pregnancy could help guide public health efforts to improve the health of pregnant individuals. OBJECTIVE To clarify the independent associations of delivery year and birth year of pregnant individuals, independent of age of pregnant individuals, with incident rates of hypertensive disorders of pregnancy. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study of 38 141 561 nulliparous individuals aged 15 to 44 years with a singleton, live birth used 1995-2019 natality data from the National Vital Statistics System. EXPOSURES Year of delivery (period) and birth year (cohort) of pregnant individuals. MAIN OUTCOMES AND MEASURES Rates of incident hypertensive disorders of pregnancy, defined as gestational hypertension, preeclampsia, or eclampsia, recorded on birth certificates. Generalized linear mixed models were used to calculate adjusted rate ratios (aRRs) comparing the incidence of hypertensive disorders of pregnancy in each delivery period (adjusted for age and cohort) and birth cohort (adjusted for age and period) with the baseline group as the reference for each. Analyses were additionally stratified by the self-reported racial and ethnic group of pregnant individuals. RESULTS Of 38 141 561 individuals, 20.2% were Hispanic, 0.8% were non-Hispanic American Indian or Alaska Native, 6.5% were non-Hispanic Asian or Pacific Islander, 13.9% were non-Hispanic Black, and 57.8% were non-Hispanic White. Among pregnant individuals who delivered in 2015 to 2019 compared with 1995 to 1999, the aRR for the incidence of hypertensive disorders of pregnancy was 1.59 (95% CI, 1.57-1.62), adjusted for age and cohort. Among pregnant individuals born in 1996 to 2004 compared with 1951 to 1959, the aRR for the incidence of hypertensive disorders of pregnancy was 2.61 (95% CI, 2.41-2.84), adjusted for age and period. The incidence was higher among self-identified non-Hispanic Black individuals in each birth cohort, with similar relative changes for period (aRR, 1.76 [95% CI, 1.70-1.81]) and cohort (aRR, 3.26 [95% CI, 2.72-3.91]) compared with non-Hispanic White individuals (period: aRR, 1.60 [95% CI, 1.57-1.63]; cohort: aRR, 2.53 [95% CI, 2.26-2.83]). CONCLUSIONS AND RELEVANCE This cross-sectional study suggests that more recent birth cohorts of pregnant individuals have experienced a doubling of rates of hypertensive disorders of pregnancy, even after adjustment for age and delivery period. Substantial racial and ethnic disparities persisted across generations.
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Affiliation(s)
- Natalie A. Cameron
- Division of Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lucia C. Petito
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M. Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natalie A. Bello
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Facco FL, Redline S, Hunter SM, Zee PC, Grobman WA, Silver RM, Louis JM, Pien GW, Mercer B, Chung JH, Bairey Merz CN, Haas DM, Nhan-Chang CL, Simhan HN, Schubert FP, Parry S, Reddy U, Saade GR, Hoffman MK, Levine LD, Wapner RJ, Catov JM, Parker CB. Sleep-disordered Breathing in Pregnancy and after Delivery: Associations with Cardiometabolic Health. Am J Respir Crit Care Med 2022; 205:1202-1213. [PMID: 35144521 PMCID: PMC9872809 DOI: 10.1164/rccm.202104-0971oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Rationale: Knowledge gaps exist regarding health implications of sleep-disordered breathing (SDB) identified in pregnancy and/or after delivery. Objectives: To determine whether SDB in pregnancy and/or after delivery is associated with hypertension (HTN) and metabolic syndrome (MS). Methods: nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be Heart Health Study) (N = 4,508) followed participants initially recruited during their first pregnancy. Participants returned for a visit 2-7 years after pregnancy. This study examined a subgroup who underwent SDB assessments during their first pregnancy (n = 1,964) and a repeat SDB assessment after delivery (n = 1,222). Two SDB definitions were considered: 1) apnea-hypopnea index (AHI) ⩾ 5 and 2) oxygen desaturation index (ODI) ⩾ 5. Associations between SDB and incident HTN and MS were evaluated with adjusted risk ratios (aRRs). Measurements and Main Results: The aRR for MS given an AHI ⩾ 5 during pregnancy was 1.44 (95% confidence interval [CI], 1.08-1.93), but no association with HTN was found. ODI ⩾ 5 in pregnancy was associated with both an increased risk for HTN (aRR, 2.02; 95% CI, 1.30-3.14) and MS (aRR, 1.53; 95% CI, 1.19-1.97). Participants with an AHI ⩾ 5 in pregnancy that persisted after delivery were at higher risk for both HTN (aRR, 3.77; 95% CI, 1.84-7.73) and MS (aRR, 2.46; 95% CI, 1.59-3.76). Similar associations were observed for persistent ODI ⩾ 5 after delivery. Conclusions: An AHI ⩾ 5 in pregnancy was associated with an increased risk of MS. An ODI ⩾ 5 in pregnancy was significantly associated with both HTN and MS. Participants with persistent elevations in AHI and ODI during pregnancy and at 2-7 years after delivery were at the highest risk for HTN and MS. Clinical trial registered with www.clinicaltrials.gov (NCT02231398).
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Affiliation(s)
- Francesca L. Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan Redline
- Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - William A. Grobman
- Department of Obstetrics, Gynecology-Maternal Fetal Medicine and Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Judette M. Louis
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Grace W. Pien
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve, MetroHealth, Cleveland, Ohio
| | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Frank P. Schubert
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Uma Reddy
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University, New Haven, Connecticut
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, University of Texas, Galveston, Texas; and
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware
| | - Lisa D. Levine
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Layden AJ, Bertolet M, Parks WT, Roberts JM, Adibi JJ, Catov JM. Latent class analysis of placental histopathology: a novel approach to classifying early and late preterm births. Am J Obstet Gynecol 2022; 227:290.e1-290.e21. [PMID: 35288092 PMCID: PMC9308632 DOI: 10.1016/j.ajog.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Neonatal morbidity attributable to prematurity predominantly occurs among early preterm births (<32 weeks) rather than late preterm births (32 to <37 weeks). Methods to distinguish early and late preterm births are lacking given the heterogeneity in pathophysiology and risk factors, including maternal obesity. Although preterm births are often characterized by clinical presentation (spontaneous or clinically indicated), classifying deliveries by placental features detected on histopathology reports may help identify subgroups of preterm births with similar etiology and risk factors. Latent class analysis is an empirical approach to characterize preterm births on the basis of observed combinations of placental features. OBJECTIVE To identify histopathologic markers that can distinguish early (<32 weeks) and late preterm births (32 to <37 weeks) that are also associated with maternal obesity and neonatal outcomes. STUDY DESIGN Women with a singleton preterm birth at University of Pittsburgh Medical Center Magee-Womens Hospital (Pittsburgh, PA) from 2008 to 2012 and a placental evaluation (89% of preterm births) were stratified into early (n=900, 61% spontaneous) and late preterm births (n=3362, 57% spontaneous). Prepregnancy body mass index was self-reported at first prenatal visit and 16 abstracted placental features were analyzed. Placental subgroups (ie, latent classes) of early and late preterm births were determined separately by latent class analysis of placental features. The optimal number of latent classes was selected by comparing fit statistics. The probability of latent class membership across prepregnancy body mass indexes was estimated in early preterm births and in late preterm births by an extension of multinomial regression called pseudo-class regression, adjusting for race, smoking, education, and parity. The frequencies of severe neonatal morbidity (composite outcome: respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, patent ductus arteriosus, and retinopathy of prematurity), small-for-gestational-age, and length of neonatal intensive care unit stay were compared across latent classes by chi-square and Kruskal-Wallis tests. RESULTS Early preterm births were grouped into 4 latent classes based on placental histopathologic features: acute inflammation (38% of cases), maternal vascular malperfusion with inflammation (29%), maternal vascular malperfusion (25%), and fetal vascular thrombosis with hemorrhage (8%). As body mass index increased from 20 to 50kg/m2, the probability of maternal vascular malperfusion and fetal vascular thrombosis with hemorrhage increased, whereas the probability of maternal vascular malperfusion with inflammation decreased. There was minimal change in the probability of acute inflammation with increasing body mass index. Late preterm births also had 4 latent classes: maternal vascular malperfusion (22%), acute inflammation (12%), fetal vascular thrombosis with hemorrhage (9%), and low-risk pathology (58%). Body mass index was not associated with major changes in likelihood of the latent classes in late preterm births. Associations between body mass index and likelihood of the latent classes were not modified by type of delivery (spontaneous or indicated) in early or late preterm births. Maternal malperfusion and fetal vascular thrombosis with hemorrhage were associated with greater neonatal morbidity than the other latent classes in early and late preterm births. CONCLUSION Obesity may predispose women to early but not late preterm birth through placental vascular impairment. Latent class analysis of placental histopathologic data provides an evidence-based approach to group preterm births with shared underlying etiology and risk factors.
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Makarem N, Chau K, Miller EC, Gyamfi-Bannerman C, Tous I, Booker WA, Catov JM, Haas D, GROBMAN W, Levine L, McNeil R, Merz NN, Reddy U, Wapner R, Wong M, Bello NA. Abstract 073: A Mediterranean Diet Pattern Is Associated With Lower Risk Of Adverse Pregnancy Outcomes In US Women: Results From The NuMoM2b Cohort. Circulation 2022. [DOI: 10.1161/circ.145.suppl_1.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Adverse pregnancy outcomes (APOs) are associated with an increased risk of developing cardiovascular disease (CVD). While the Mediterranean diet pattern has been inversely related to CVD outcomes, its association with APOs in US women has not been previously evaluated.
Hypothesis:
Adherence to a Mediterranean diet pattern during the periconception period is associated with lower risk of APOs.
Methods:
Racially and ethnically diverse women (n=8075, mean age: 27±6y) from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) cohort were enrolled across 8 US medical centers from 2010-13. An Alternate Mediterranean Diet (aMed) score was computed from data on habitual diet in the 3 months around conception, assessed using a semi-quantitative food frequency questionnaire in the first trimester. APOs were prospectively ascertained and defined as developing 1 or more of the following: gestational hypertension, preeclampsia/eclampsia, gestational diabetes, preterm delivery, small for gestational age, or stillbirth. Multivariable logistic regression was used to examine associations of the aMed score and its components with any APO and individual APOs.
Results:
Women in the highest vs. lowest quintile of the aMed score had 21% lower odds of developing any APO, and 36% and 52% lower odds of preeclampsia/eclampsia and gestational diabetes, respectively; a linear trend across aMed score categories was detected (p-trend<0.05) (
Figure
). When aMed score components were examined separately, higher intakes of vegetables, fruits, legumes, and fish and lower intakes of red meat were related to up to 26% lower odds of APOs.
Conclusions:
Greater adherence to a Mediterranean diet pattern is related to lower risk of APOs, with evidence of a dose-response relationship, highlighting the potential of this diet pattern in CVD primordial prevention efforts in US women. Long-term studies are needed to assess whether dietary modification in the periconception period can reduce risk of APOs and future CVD.
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Affiliation(s)
- Nour Makarem
- COLUMBIA UNIVERSITY MEDICAL CENTER, New York, NY
| | - Kristi Chau
- COLUMBIA UNIVERSITY MEDICAL CENTER, New York, NY
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Hauspurg A, Marsh DJ, McNeil RB, Bairey Merz CN, Greenland P, Straub AC, Rouse CE, Grobman WA, Pemberton VL, Silver RM, Chen YDI, Mercer BM, Levine LD, Hameed A, Hoffman MK, Simhan HN, Catov JM. Association of N-Terminal Pro-Brain Natriuretic Peptide Concentration in Early Pregnancy With Development of Hypertensive Disorders of Pregnancy and Future Hypertension. JAMA Cardiol 2022; 7:268-276. [PMID: 35044418 PMCID: PMC8771430 DOI: 10.1001/jamacardio.2021.5617] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Hypertensive disorders of pregnancy are associated with future cardiovascular disease, perhaps because of subclinical cardiac dysfunction before pregnancy leading to impaired adaptation to pregnancy. Natriuretic peptides are promising biomarkers for detecting subclinical cardiac dysfunction outside of pregnancy. OBJECTIVE To investigate whether higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) in early pregnancy would be associated with hypertensive disorders of pregnancy and hypertension 2 to 7 years post partum. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study, a prospective multicenter observational study. A total of 4103 nulliparous women with complete data and no prepregnancy hypertension or diabetes who were treated at 8 clinical sites were included. Women were followed up with for 2 to 7 years after pregnancy. Data were collected from October 2010 to October 2017, and data were analyzed from August 2020 to November 2021. EXPOSURES NT-proBNP concentration, measured using an electrochemiluminescence immunoassay from a first-trimester blood sample. MAIN OUTCOMES AND MEASURES Hypertensive disorders of pregnancy and incident hypertension (systolic blood pressure of 130 mm Hg or diastolic blood pressure of 80 mm Hg or use of antihypertensive agents) at follow-up visit. RESULTS A total of 4103 women met inclusion criteria; the mean (SD) age was 27.0 (5.6) years. Among these women, 909 (22.2%) had an adverse pregnancy outcome, and 817 (19.9%) had hypertension at the follow-up visit. Higher NT-proBNP concentrations were associated with a lower risk of hypertensive disorders of pregnancy (adjusted odds ratio per doubling, 0.81; 95% CI, 0.73-0.91), which persisted after adjustment for age, self-reported race and ethnicity, early-pregnancy body mass index, smoking, and aspirin use. Similarly, higher NT-proBNP concentration in early pregnancy was also associated with a lower risk of incident hypertension 2 to 7 years after delivery (adjusted odds ratio per doubling, 0.84; 95% CI, 0.77-0.93), an association that persisted after controlling for confounders, including hypertensive disorders of pregnancy. CONCLUSIONS AND RELEVANCE In this cohort study, higher NT-proBNP concentrations in early pregnancy were associated with a lower risk of hypertensive disorders of pregnancy and hypertension 2 to 7 years post partum. These findings suggest that normal early-pregnancy cardiovascular physiology, as assessed by NT-proBNP concentration, may provide biologic insights into both pregnancy outcome and cardiovascular disease risk.
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Affiliation(s)
- Alisse Hauspurg
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Derek J. Marsh
- RTI International, Research Triangle Park, North Carolina
| | | | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California
| | - Philip Greenland
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adam C. Straub
- Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Victoria L. Pemberton
- The National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Yii-Der Ida Chen
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Los Angeles, California
| | - Brian M. Mercer
- Case Western Reserve University, The MetroHealth System, Cleveland, Ohio
| | - Lisa D. Levine
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | | | - Hyagriv N. Simhan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janet M. Catov
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Catov JM, Sun B, Lewis CE, Bertolet M, Gunderson EP. Prepregnancy weight change associated with high gestational weight gain. Obesity (Silver Spring) 2022; 30:524-534. [PMID: 35080338 PMCID: PMC9996907 DOI: 10.1002/oby.23354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Gestational weight gain (GWG) above recommendations is a risk factor for adverse maternal, perinatal, and long-term outcomes. This study hypothesized that prepregnancy weight gain may portend excess GWG. METHODS Among 1,126 women (51% of whom were of Black race) in the Coronary Artery Risk Development in Young Adults (CARDIA) study with post-baseline births, the prepregnancy annual rate of BMI change per woman was estimated (slope; 5 years before pregnancy) and was related to the risk of GWG above Institute of Medicine recommendations using mixed-effects models (binary) and GWG z score (continuous), adjusting for confounders, and stratified by prepregnancy overweight/obesity status. RESULTS A total of 626 women (56%) had excess GWG. Each standard deviation increase in prepregnancy BMI (0.16 kg/m2 per year) was associated with an 18% increased risk of excess GWG (95% CI: 1.13-1.23), adjusted for covariates. Stratified results showed an association for women without overweight or obesity (adjusted relative risk = 1.71 [95% CI: 1.38-2.13]) but not among those with overweight or obesity (adjusted relative risk = 0.98 [95% CI: 0.91-1.05]). When evaluated as a z score, prepregnancy weight gain was associated with higher GWG among women with and without overweight or obesity (mean = 0.24 [0.10] and 0.28 [0.12] z score, respectively). CONCLUSIONS Weight gain before pregnancy is associated with higher GWG during pregnancy. Assessment of prepregnancy weight changes may identify those at risk for high GWG.
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Affiliation(s)
- Janet M Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Magee-Women's Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Baiyang Sun
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marnie Bertolet
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Catov JM, Muldoon MF, Gandley RE, Brands J, Hauspurg A, Hubel CA, Tuft M, Schmella M, Tang G, Parks WT. Maternal Vascular Lesions in the Placenta Predict Vascular Impairments a Decade After Delivery. Hypertension 2022; 79:424-434. [PMID: 34879703 PMCID: PMC9026545 DOI: 10.1161/hypertensionaha.121.18394] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Women with adverse pregnancy outcomes later experience excess hypertension and cardiovascular disease, but how the events are linked is unknown. Examination of the placenta may provide clues to vascular impairments after delivery. Maternal vascular malperfusion lesions (MVMs) were abstracted from clinical reports, validated and characterized using clinical guidelines and severity score. A total of 492 women (170 with MVMs and 322 without MVMs) participated in a study visit 8 to 10 years after delivery to assess blood pressure, cardiometabolic factors, and sublingual microvascular features using sidestream dark field imaging. Covariates included age, race, adverse pregnancy outcomes (preeclampsia, small for gestational age, and preterm birth), and health behaviors. Women with versus without MVM had a distinct sublingual microvascular profile comprised of (1) lower microvascular density (-410 μm/mm2, P=0.015), (2) higher red blood cell filling as a marker of perfusion (2%, P=0.004), and (3) smaller perfused boundary region (-0.07 µm, P=0.025) as a measure of glycocalyx integrity, adjusted for covariates including adverse pregnancy outcomes. Women with MVM also had higher adjusted diastolic blood pressure (+2.6 mm Hg, P=0.021), total and LDL (low-density lipoprotein)-cholesterol (+11.2 mg/dL, P=0.016; +8.7 mg/dL, P=0.031). MVM associations with subsequent cardiovascular measures did not vary by type of adverse pregnancy outcome, except among women with preterm births where blood pressure was higher only among those with MVM. Results were similar when evaluated as MVM severity. A decade after delivery, women with placental vascular lesions had an adverse cardiovascular profile comprised of microvascular rarefaction, higher blood pressure and more atherogenic lipids. Placental histopathology may reveal a woman's early trajectory toward subsequent vascular disease.
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Affiliation(s)
- JM Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Magee-Women’s Research Institute, University of Pittsburgh,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - MF Muldoon
- Cardiology Division, Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania
| | - RE Gandley
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Magee-Women’s Research Institute, University of Pittsburgh
| | - J Brands
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Magee-Women’s Research Institute, University of Pittsburgh
| | - A Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh
| | - CA Hubel
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Magee-Women’s Research Institute, University of Pittsburgh
| | - M Tuft
- Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - M Schmella
- School of Nursing, University of Pittsburgh, Pennsylvania
| | - G Tang
- Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - WT Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto
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Alansare AB, Gibbs BB, Catov JM, Jennings JR, Kline CE, Nagle E, Holzman C. Association of Physical Activity and Sedentary Time with Cardio-Autonomic Regulation in Women. J Womens Health (Larchmt) 2021; 31:600-608. [PMID: 34648723 DOI: 10.1089/jwh.2021.0243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Low moderate-to-vigorous-intensity physical activity (MVPA) and high sedentary time (ST) may contribute to cardiovascular disease (CVD) risk in women, perhaps via cardiac autonomic dysregulation. We examined associations of total, leisure, and occupational MVPA and ST with cardiac autonomic regulation in women. Methods: Data were from 522 women (age = 37.7 ± 5.7 years; 59%white) who participated in the follow-up study of the Pregnancy Outcomes and Community Health Study (between 2011 and 2014). MVPA and ST (hours/day) were self-reported using the Modifiable Activity Questionnaire. Cardiac autonomic regulation was assessed by calculating heart rate variability (HRV) indices (resting heart rate, natural logarithm standard deviation of normal R-R intervals; lnSDNN [total variability], natural logarithm root mean square of the successive differences; lnRMSSD [cardiac parasympathetic activity]) with Kubios software from a 5-minute, seated electrocardiogram. Progressive generalized linear models evaluated associations of total, leisure, and occupational MVPA and ST with HRV indices while adjusting for confounders (demographics, health-related factors), and then potential mediators (clinical variables). A final model evaluated the relationship between ST and HRV stratified by MVPA level. Results: Adjusting for confounders, total and leisure MVPA were associated with favorable lnSDNN (B = 0.027 [p = 0.014] and B = 0.074 [p = 0.009], respectively) and lnRMSSD (B = 0.036 [p = 0.015] and B = 0.075 [p = 0.043], respectively). Adjustment for mediators tended to strengthen the observed significant associations. No associations were found between occupational MVPA or any ST measure with HRV indices (p > 0.05). Neither MVPA nor ST were associated with heart rate. When stratified by MVPA level, leisure ST was associated with unfavorable lnRMSSD (B = -0.041, [p = 0.042]) only among women who did not meet leisure MVPA recommendations. Conclusion: Cardiac autonomic dysregulation may be a mechanism through which low leisure MVPA and, among low-active women, high leisure ST contribute to CVD risk among women.
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Affiliation(s)
- Abdullah Bandar Alansare
- Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, Riyadh, Saudi Arabia
| | - Bethany Barone Gibbs
- Department of Health and Human Development, School of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet M Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences and University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J Richard Jennings
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher E Kline
- Department of Health and Human Development, School of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Nagle
- Department of Health and Human Development, School of Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Claudia Holzman
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
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Abatemarco DJ, Gannon M, Short VL, Baxter J, Metzker KM, Reid L, Catov JM. Mindfulness in Pregnancy: A Brief Intervention for Women at Risk. Matern Child Health J 2021; 25:1875-1883. [PMID: 34618309 DOI: 10.1007/s10995-021-03243-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The U.S. has the highest rate of preterm birth (PTB), of all developed countries, especially among African American women. Social determinants of health and inequalities in health outcomes are understudied areas. The intersectionality of race and socioeconomic status has been shown to contribute to chronic stress, stress has been shown to be associated with PTB, yet the mechanisms that affect pregnancy outcomes have not been explicit. Mindfulness-based Interventions that address stress reduction during pregnancy may improve quality of life during pregnancy, perhaps enhancing resilience, and be on the pathway to reducing the risk of negative pregnancy outcomes such as PTB. METHODS We over-enrolled African American women and those covered by Medicaid to reach women at higher risk for PTB and included women in substance use treatment. Participants were enrolled in a 6-week mindfulness in pregnancy (MIP) intervention at the obstetric clinic. Sociodemographic characteristics and psychosocial assessments were obtained at three time points. RESULTS We enrolled 35 women who self-identified as: non-white, Medicaid recipients, aged 25-35 years, with high school or less education. We found reductions in perceived stress, pregnancy specific stress, trait anxiety and depression and increases in mindfulness that sustained post-intervention at 2 and 7 months. DISCUSSION Social determinants and stress in particular have been associated with negative birth outcomes. This paper describes a brief intervention and results of MIP tailored to women who have significantly more stress due to race, poverty, homelessness, substance use treatment and other comorbid health risks including PTB.
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Affiliation(s)
- Diane J Abatemarco
- Maternal Addiction Treatment, Education and Research (MATER), Departments of Obstetrics, Gynecology, and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, 1233 Locust St, Suite 401, Philadelphia, PA, 19107, USA.
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Vanessa L Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, USA
| | - Jason Baxter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, USA
| | | | - Lindsay Reid
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Janet M Catov
- Departments of Obstetrics, Gynecology and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, USA
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Alansare AB, Gibbs BB, Catov JM, Jennings JR, Kline CE, Nagle E, Holzman C. Associations Of Domain-specific Sedentary Time And Physical Activity With Heart Rate Variability In Women. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000759888.30455.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Countouris ME, Villanueva FS, Catov JM. Reply: Cardiovascular Prevention After Hypertensive Disorders of Pregnancy: Do Not Forget Fetal Growth Restriction! J Am Coll Cardiol 2021; 78:91-92. [PMID: 34210420 DOI: 10.1016/j.jacc.2021.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
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Kim K, Joyce BT, Zheng Y, Schreiner PJ, Jacobs DR, Catov JM, Shikany JM, Carnethon MR, Greenland P, Van Horn LV, Allen NB, Lloyd-Jones DM, Gunderson EP, Hou L. DNA Methylation GrimAge and Incident Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Diabetes 2021; 70:1404-1413. [PMID: 33820761 PMCID: PMC8275890 DOI: 10.2337/db20-1167] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/27/2021] [Indexed: 12/21/2022]
Abstract
DNA methylation (DNAm)-based biological age (epigenetic age) has been suggested as a useful biomarker of age-related conditions including type 2 diabetes (T2D), and its newest iterations (GrimAge measurements) have shown early promise. In this study, we explored the association between epigenetic age and incident T2D in the context of their relationships with obesity. A total of 1,057 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study were included in the current analyses. We stratified the participants into three groups: normal weight, overweight, and obese. A 1-year increase of GrimAge was associated with higher 10-year (study years 15-25) incidence of T2D (odds ratio [OR] 1.06, 95% CI 1.01-1.11). GrimAge acceleration, which represents the deviation of GrimAge from chronological age, was derived from the residuals of a model of GrimAge and chronological age, and any GrimAge acceleration (positive GrimAA: having GrimAge older than chronological age) was associated with significantly higher odds of 10-year incidence of T2D in obese participants (OR 2.57, 95% CI 1.61-4.11). Cumulative obesity was estimated by years since obesity onset, and GrimAge partially mediated the statistical association between cumulative obesity and incident diabetes or prediabetes (proportion mediated = 8.0%). In conclusion, both older and accelerated GrimAge were associated with higher risk of T2D, particularly among obese participants. GrimAge also statistically mediated the associations between cumulative obesity and T2D. Our findings suggest that epigenetic age measurements with DNAm can potentially be used as a risk factor or biomarker associated with T2D development.
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Affiliation(s)
- Kyeezu Kim
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Brian T Joyce
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yinan Zheng
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda V Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lifang Hou
- Center for Global Oncology, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Birru RL, Liang HW, Farooq F, Bedi M, Feghali M, Haggerty CL, Mendez DD, Catov JM, Ng CA, Adibi JJ. A pathway level analysis of PFAS exposure and risk of gestational diabetes mellitus. Environ Health 2021; 20:63. [PMID: 34022907 PMCID: PMC8141246 DOI: 10.1186/s12940-021-00740-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/27/2021] [Indexed: 05/12/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) have been found to be associated with gestational diabetes mellitus (GDM) development, a maternal health disorder in pregnancy with negative effects that can extend beyond pregnancy. Studies that report on this association are difficult to summarize due to weak associations and wide confidence intervals. One way to advance this field is to sharpen the biologic theory on a causal pathway behind this association, and to measure it directly by way of molecular biomarkers. The aim of this review is to summarize the literature that supports a novel pathway between PFAS exposure and GDM development. Epidemiological studies demonstrate a clear association of biomarkers of thyroid hormones and glucose metabolism with GDM development. We report biologic plausibility and epidemiologic evidence that PFAS dysregulation of maternal thyroid hormones and thyrotropin (TSH) may disrupt glucose homeostasis, increasing the risk of GDM. Overall, epidemiological studies demonstrate that PFAS were positively associated with TSH and negatively with triiodothyronine (T3) and thyroxine (T4). PFAS were generally positively associated with glucose and insulin levels in pregnancy. We propose dysregulation of thyroid function and glucose metabolism may be a critical and missing component in the accurate estimation of PFAS on the risk of GDM.
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Affiliation(s)
- Rahel L. Birru
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Hai-Wei Liang
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Fouzia Farooq
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Megha Bedi
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, PA USA
| | - Maisa Feghali
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Catherine L. Haggerty
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Dara D. Mendez
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Janet M. Catov
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Carla A. Ng
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, PA USA
- Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Jennifer J. Adibi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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Shaaban CE, Rosano C, Cohen AD, Huppert T, Butters MA, Hengenius J, Parks WT, Catov JM. Cognition and Cerebrovascular Reactivity in Midlife Women With History of Preeclampsia and Placental Evidence of Maternal Vascular Malperfusion. Front Aging Neurosci 2021; 13:637574. [PMID: 34017243 PMCID: PMC8129174 DOI: 10.3389/fnagi.2021.637574] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/09/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Preeclampsia is emerging as a sex-specific risk factor for cerebral small vessel disease (SVD) and dementia, but the reason is unknown. We assessed the relationship of maternal vascular malperfusion (MVM), a marker of placental SVD, with cognition and cerebral SVD in women with and without preeclampsia. We hypothesized women with both preeclampsia and MVM would perform worst on information processing speed and executive function. Methods: Women (n = 45; mean 10.5 years post-delivery; mean age: 41 years; 42.2% Black) were classified as preeclampsia-/MVM-, preeclampsia+/MVM-, or preeclampsia+/MVM+. Information processing speed, executive function, and memory were assessed. In a pilot sub-study of cerebrovascular reactivity (CVR; n = 22), cerebral blood flow during room-air breathing and breath-hold induced hypercapnia were obtained via arterial spin labeling MRI. Non-parametric tests and regression models were used to test associations. Results: Between-group cognitive differences were significant for information processing speed (p = 0.02); preeclampsia+/MVM+ had the lowest scores. Cerebral blood flow increased from room-air to breath-hold, globally and in all regions in the three groups, except the preeclampsia+/MVM+ parietal region (p = 0.12). Lower parietal CVR (less change from room-air breathing to breath-holding) was correlated with poorer information processing speed (partial ρ = 0.63, p = 0.005) and executive function (ρ = 0.50, p = 0.03) independent of preeclampsia/MVM status. Conclusion: Compared to women without preeclampsia and MVM, midlife women with both preeclampsia and MVM have worse information processing speed and may have blunted parietal CVR, an area important for information processing speed and executive function. MVM in women with preeclampsia is a promising sex-specific indicator of cerebrovascular integrity in midlife.
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Affiliation(s)
- C Elizabeth Shaaban
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Theodore Huppert
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - James Hengenius
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - W Tony Parks
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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Jones MA, Catov JM, Jeyabalan A, Whitaker KM, Gibbs BB. Sedentary behaviour and physical activity across pregnancy and birth outcomes. Paediatr Perinat Epidemiol 2021; 35:341-349. [PMID: 33124060 PMCID: PMC8186559 DOI: 10.1111/ppe.12731] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/06/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Shorter gestation or smaller birth size are indicators of a suboptimal fetal environment and negatively impact short- and long-term offspring health. Understanding how modifiable maternal behaviours, such as moderate-to-vigorous intensity physical activity (MVPA) or sedentary behaviour (SED), improve fetal outcomes could inform strategies to improve health across the lifespan. OBJECTIVES The objective of this study was to examine the association of MVPA and SED across pregnancy trimesters on gestational age at delivery and newborn anthropometrics. METHODS The MoM Health Study measured SED (thigh-mounted activPAL3 micro) and MVPA (waist-worn Actigraph GTX3) in each trimester of pregnancy. Birth outcomes (gestational age at delivery, birthweight, birth length, and head circumference) were abstracted from medical records and used to calculate ponderal index (grams*100/cm3 ) and size-for-gestational age percentiles. Associations of group-based trajectories and trimester-specific SED and MVPA with birth outcomes were analysed using regression models. RESULTS Low, medium, and high trajectory groups were generated SED and MVPA in 103 and 99 pregnant women, respectively. High vs low SED trajectory was associated with earlier gestational age at delivery (β -1.03 weeks, 95% CI -2.01, -0.06), larger head circumference (β 0.83 cm, 95% CI 0.24, 1.63), longer birth length (β 1.37 cm, 95% CI 0.09, 2.64), and lower ponderal index (β -0.24 g*100/cm3 , 95% CI -0.42, -0.06), after adjustment for demographics, pre-pregnancy BMI, and (for newborn anthropometric outcomes) gestational age. The association of high SED with lower ponderal index was the most robust across progressively adjusted models (β -0.25 g*100/cm3 , 95% CI -0.44, -0.07). SED trajectory was not associated with birthweight or size-for-gestational age. High vs low MVPA trajectory was only associated with smaller head circumference (β -0.86 cm, 95% CI -1.70, -0.02). CONCLUSIONS Higher SED during pregnancy may result in shorter gestation and inhibited fetal growth. Further research evaluating the effect of reducing SED during pregnancy on birth outcomes is warranted.
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Affiliation(s)
- Melissa A. Jones
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janet M. Catov
- Department of Ob/Gyn and Reproductive Sciences, Magee-Womens Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arun Jeyabalan
- Department of Ob/Gyn and Reproductive Sciences, Magee-Womens Research Institute and Clinical and Translational Sciences Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kara M. Whitaker
- Department of Health and Human Physiology, Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
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Gunderson EP, Sun B, Catov JM, Carnethon M, Lewis CE, Allen NB, Sidney S, Wellons M, Rana JS, Hou L, Carr JJ. Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study. Circulation 2021; 143:974-987. [PMID: 33517667 PMCID: PMC7940578 DOI: 10.1161/circulationaha.120.047320] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gestational diabetes (GD) leads to earlier onset and heightened risk of type 2 diabetes, a strong risk factor for cardiovascular disease (CVD). However, it is unclear whether attaining normoglycemia can ameliorate the excess CVD risk associated with GD history. This study sought to evaluate GD history and glucose tolerance after pregnancy associated with coronary artery calcification (CAC) in women, a manifestation of atherosclerotic CVD and a predictor of CVD clinical events. METHODS Data were obtained from the CARDIA study (Coronary Artery Risk Development in Young Adults), a US multicenter, community-based prospective cohort of young Black (50%) and White adults aged 18 to 30 years at baseline (1985-1986). The sample included 1133 women without diabetes at baseline, who had ≥1 singleton births (n=2066) during follow-up, glucose tolerance testing at baseline and up to 5 times during 25 years (1986-2011), GD status, and CAC measurements obtained from 1 or more follow up examinations at years 15, 20, and 25 (2001-2011). CAC was measured by noncontrast cardiac computed tomography; dichotomized as Any CAC (score>0) or No CAC (score=0). Complementary log-log models for interval-censored data estimated adjusted hazard ratios of CAC and 95% confidence intervals for GD history and subsequent glucose tolerance groups (normoglycemia, prediabetes, or incident diabetes) on average 14.7 years after the last birth adjusted for prepregnancy and follow-up covariates. RESULTS Of 1133 women, 139 (12.3%) reported GD and were 47.6 years of age (4.8 SD) at follow-up. CAC was present in 25% (34/139) of women with GD and 15% (149/994) of women with no GD. In comparison with no GD/normoglycemia, adjusted hazard ratios (95% CIs) were 1.54 (1.06-2.24) for no GD/prediabetes and 2.17 (1.30-3.62) for no GD/incident diabetes, and 2.34 (1.34-4.09), 2.13 (1.09-4.17), and 2.02 (0.98-4.19) for GD/normoglycemia, GD/prediabetes, and GD/incident diabetes, respectively (overall P=0.003). CONCLUSIONS Women without previous GD showed a graded increase in the risk of CAC associated with worsening glucose tolerance. Women with a history of GD had a 2-fold higher risk of CAC across all subsequent levels of glucose tolerance. Midlife atherosclerotic CVD risk among women with previous GD is not diminished by attaining normoglycemia.
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Affiliation(s)
- Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Baiyang Sun
- Departments of OB/GYN and Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Janet M. Catov
- Departments of OB/GYN and Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | | | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Norrina B. Allen
- Department of Epidemiology, Northwestern University, Chicago, IL
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Jamal S. Rana
- Division of Research and the Department of Cardiology, Kaiser Permanente Northern, California, Oakland, CA
| | - Lifang Hou
- Department of Epidemiology, Northwestern University, Chicago, IL
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Countouris ME, Villanueva FS, Berlacher KL, Cavalcante JL, Parks WT, Catov JM. Association of Hypertensive Disorders of Pregnancy With Left Ventricular Remodeling Later in Life. J Am Coll Cardiol 2021; 77:1057-1068. [PMID: 33632480 PMCID: PMC10544734 DOI: 10.1016/j.jacc.2020.12.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with short-term cardiac structure and function abnormalities, but later life changes are not well studied. OBJECTIVES This study aimed to determine if HDP history is associated with echocardiographic differences 8 to 10 years after delivery, and if subgroups with placental maternal vascular malperfusion (MVM) lesions or current hypertension may be particularly affected. METHODS Women with pregnancies delivered from 2008 to 2009 were selected from a clinical cohort with abstracted pregnancy and placental pathology data to undergo transthoracic echocardiography (2017 to 2020). Medical history, blood pressure, and weight were measured at the study visit. RESULTS The authors enrolled 132 women (10 ± 1 years post-delivery, age 38 ± 6 years): 102 with normotensive pregnancies and 30 with HDP: pre-eclampsia (n = 21) or gestational hypertension (n = 9). Compared with women with normotensive pregnancies, those with HDP history were more likely to have current hypertension (63% vs. 26%; p < 0.001). After adjusting for age, race, MVM lesions, body mass index, current hypertension, and hemoglobin A1c, women with HDP history had higher interventricular septal thickness (β = 0.08; p = 0.04) and relative wall thickness (β = 0.04; p = 0.04). In subgroup analyses, those with both HDP history and current hypertension had a higher proportion of left ventricular remodeling (79.0%) compared with all other groups (only HDP [36.4%; p = 0.01], only current hypertension [46.2%; p = 0.02], and neither HDP nor hypertension [38.2%; p < 0.001]), and lower mitral inflow E/A and annular e'. Accounting for placental MVM lesions did not impact results. CONCLUSIONS Women with both HDP history and current hypertension have pronounced differences in left ventricular structure and function a decade after pregnancy, warranting continued surveillance and targeted therapies for cardiovascular disease prevention.
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Affiliation(s)
- Malamo E Countouris
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA.
| | - Flordeliza S Villanueva
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Kathryn L Berlacher
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Janet M Catov
- Department of Obstetrics, Gynecology, and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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42
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Catov JM, McNeil RB, Marsh DJ, Mercer BM, Bairey Merz CN, Parker CB, Pemberton VL, Saade GR, Chen YDI, Chung JH, Ehrenthal DB, Grobman WA, Haas DM, Parry S, Polito L, Reddy UM, Silver RM, Simhan HN, Wapner RJ, Kominiarek M, Kreutz R, Levine LD, Greenland P. Early Pregnancy Atherogenic Profile in a First Pregnancy and Hypertension Risk 2 to 7 Years After Delivery. J Am Heart Assoc 2021; 10:e017216. [PMID: 33619977 PMCID: PMC8174276 DOI: 10.1161/jaha.120.017216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Cardiovascular risk in young adulthood is an important determinant of lifetime cardiovascular disease risk. Women with adverse pregnancy outcomes (APOs) have increased cardiovascular risk, but the relationship of other factors is unknown. Methods and Results Among 4471 primiparous women, we related first‐trimester atherogenic markers to risk of APO (hypertensive disorders of pregnancy, preterm birth, small for gestational age), gestational diabetes mellitus (GDM) and hypertension (130/80 mm Hg or antihypertensive use) 2 to 7 years after delivery. Women with an APO/GDM (n=1102) had more atherogenic characteristics (obesity [34.2 versus 19.5%], higher blood pressure [systolic blood pressure 112.2 versus 108.4, diastolic blood pressure 69.2 versus 66.6 mm Hg], glucose [5.0 versus 4.8 mmol/L], insulin [77.6 versus 60.1 pmol/L], triglycerides [1.4 versus 1.3 mmol/L], and high‐sensitivity C‐reactive protein [5.6 versus 4.0 nmol/L], and lower high‐density lipoprotein cholesterol [1.8 versus 1.9 mmol/L]; P<0.05) than women without an APO/GDM. They were also more likely to develop hypertension after delivery (32.8% versus 18.1%, P<0.05). Accounting for confounders and factors routinely assessed antepartum, higher glucose (relative risk [RR] 1.03 [95% CI, 1.00–1.06] per 0.6 mmol/L), high‐sensitivity C‐reactive protein (RR, 1.06 [95% CI, 1.02–1.11] per 2‐fold higher), and triglycerides (RR, 1.27 [95% CI, 1.14–1.41] per 2‐fold higher) were associated with later hypertension. Higher physical activity was protective (RR, 0.93 [95% CI, 0.87‐0.99] per 3 h/week). When evaluated as latent profiles, the nonobese group with higher lipids, high‐sensitivity C‐reactive protein, and insulin values (6.9% of the cohort) had increased risk of an APO/GDM and later hypertension. Among these factors, 7% to 15% of excess RR was related to APO/GDM. Conclusions Individual and combined first‐trimester atherogenic characteristics are associated with APO/GDM occurrence and hypertension 2 to 7 years later. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02231398.
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Affiliation(s)
- Janet M Catov
- University of Pittsburgh School of Medicine Pittsburgh PA
| | | | | | - Brian M Mercer
- Case Western Reserve University-The MetroHealth System Cleveland OH
| | | | | | | | | | | | | | | | | | - David M Haas
- Indiana University School of Medicine Indianapolis IN
| | - Samuel Parry
- University of Pennsylvania School of Medicine Philadelphia PA
| | - LuAnn Polito
- Case Western Reserve University-The MetroHealth System Cleveland OH
| | - Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development Bethesda MD
| | | | | | | | | | - Rolf Kreutz
- Indiana University School of Medicine Indianapolis IN
| | - Lisa D Levine
- University of Pennsylvania School of Medicine Philadelphia PA
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43
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Spehar SM, Gibbs BB, Muldoon M, Catov JM. Association of sedentary time with blood pressure in women of reproductive age. Prev Med Rep 2020; 20:101219. [PMID: 33145150 PMCID: PMC7593624 DOI: 10.1016/j.pmedr.2020.101219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/03/2020] [Accepted: 09/25/2020] [Indexed: 11/18/2022] Open
Abstract
While the beneficial impact of moderate-vigorous physical activity (MVPA) on blood pressure is well-understood, the relationship between sedentary time (ST) and blood pressure is less clear. We aimed to evaluate the associations between ST and BP in reproductive-age women. This cross-sectional analysis consisted of 431 women enrolled in the Placenta as a Window to Maternal Microvascular Disease Risk study at Magee-Womens Hospital. Blood pressure and self-reported physical activity and ST were collected 8–10 years after delivery at study enrollment. Logistic and linear regression models examined associations between ST and blood pressure and adjusted for MVPA. Women with the highest amount of ST were less likely to be normotensive and more likely to have elevated blood pressure and Stage II hypertension (p = 0.02). Each additional hour of ST was associated with an increased risk of Stage II hypertension (OR 1.12 [1.01–1.24]) and higher systolic blood pressure (0.45 mmHg [0.08–0.82]), diastolic blood pressure (0.29 mmHg [0.02–0.56]), and mean arterial pressure (0.34 mmHg [0.05–0.63]), after adjustment for covariates. This relationship was more apparent in women who participated in less MVPA (bottom 50th percentile) versus more MVPA (top 50th percentile). ST is associated with higher blood pressure, particularly in women who engage in less aerobic activity, and could serve as an important intervention target for reducing blood pressure and hypertension during the reproductive years.
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Affiliation(s)
- Stephanie M. Spehar
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
- Corresponding author at: 3116 Taubman Center, SPC 5368, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5368, United States.
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, School of Education, University of Pittsburgh, Pittsburgh, PA, United States
| | - Matthew Muldoon
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences and Epidemiology, University of Pittsburgh, School of Medicine and Graduate School of Public Health, Pittsburgh, PA, United States
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44
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Gooding HC, Gidding SS, Moran AE, Redmond N, Allen NB, Bacha F, Burns TL, Catov JM, Grandner MA, Harris KM, Johnson HM, Kiernan M, Lewis TT, Matthews KA, Monaghan M, Robinson JG, Tate D, Bibbins-Domingo K, Spring B. Challenges and Opportunities for the Prevention and Treatment of Cardiovascular Disease Among Young Adults: Report From a National Heart, Lung, and Blood Institute Working Group. J Am Heart Assoc 2020; 9:e016115. [PMID: 32993438 PMCID: PMC7792379 DOI: 10.1161/jaha.120.016115] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Improvements in cardiovascular disease (CVD) rates among young adults in the past 2 decades have been offset by increasing racial/ethnic and gender disparities, persistence of unhealthy lifestyle habits, overweight and obesity, and other CVD risk factors. To enhance the promotion of cardiovascular health among young adults 18 to 39 years old, the medical and broader public health community must understand the biological, interpersonal, and behavioral features of this life stage. Therefore, the National Heart, Lung, and Blood Institute, with support from the Office of Behavioral and Social Science Research, convened a 2-day workshop in Bethesda, Maryland, in September 2017 to identify research challenges and opportunities related to the cardiovascular health of young adults. The current generation of young adults live in an environment undergoing substantial economic, social, and technological transformations, differentiating them from prior research cohorts of young adults. Although the accumulation of clinical and behavioral risk factors for CVD begins early in life, and research suggests early risk is an important determinant of future events, few trials have studied prevention and treatment of CVD in participants <40 years old. Building an evidence base for CVD prevention in this population will require the engagement of young adults, who are often disconnected from the healthcare system and may not prioritize long-term health. These changes demand a repositioning of existing evidence-based treatments to accommodate new sociotechnical contexts. In this article, the authors review the recent literature and current research opportunities to advance the cardiovascular health of today's young adults.
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Affiliation(s)
- Holly C Gooding
- Division of General Pediatrics and Adolescent Medicine Emory UniversityChildren's Healthcare of Atlanta Atlanta GA
| | | | - Andrew E Moran
- Division of General Medicine Columbia University New York NY
| | | | - Norrina B Allen
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Fida Bacha
- Division of Pediatric Endocrinology and Diabetes Texas Children's HospitalBaylor College of Medicine Houston TX
| | - Trudy L Burns
- Department of Epidemiology University of Iowa Iowa City IA
| | - Janet M Catov
- Department of Obstetrics, Gynecology & Reproductive Sciences Department of Epidemiology University of Pittsburgh Pittsburgh PA
| | | | | | - Heather M Johnson
- Blechman Center for Specialty Care and Preventive Cardiology Boca Raton Regional Hospital/Baptist Health South Florida Boca Raton FL
| | - Michaela Kiernan
- Department of Medicine Stanford University School of Medicine Stanford CA
| | - Tené T Lewis
- Department of Epidemiology Emory University, Children's Healthcare of Atlanta Atlanta GA
| | | | - Maureen Monaghan
- Department of Psychiatry and Behavioral Sciences Department of Pediatrics Children's National Health System George Washington University School of Medicine Washington DC
| | | | - Deborah Tate
- Department of Sociology University of North Carolina at Chapel Hill Chapel Hill NC
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics University of California San Francisco San Francisco CA
| | - Bonnie Spring
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
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45
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Holzman CB, Senagore P, Xu J, Dunietz GL, Strutz KL, Tian Y, Bullen BL, Eagle M, Catov JM. Maternal risk of hypertension 7-15 years after pregnancy: clues from the placenta. BJOG 2020; 128:827-836. [PMID: 32931608 DOI: 10.1111/1471-0528.16498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether pre-eclampsia (PE)-related placental/extraplacental membrane findings are linked to moderately elevated blood pressure (BP) in pregnancy and later-life hypertension. DESIGN Prospective cohort. SETTING 52 prenatal clinics, 5 Michigan communities. SAMPLE The POUCH Study recruited women at 16-27 weeks' gestation (1998-2004) and studied a sub-cohort in depth. This sample (n = 490) includes sub-cohort women with detailed placental assessments and cardiovascular health evaluations 7-15 years later in the POUCHmoms follow-up study. METHODS PE-related placental/extraplacental membrane findings (i.e. mural hyperplasia, unaltered/abnormal vessels or atherosis in decidua; infarcts) were evaluated in relation to pregnancy BP and odds of Stage 2 hypertension at follow up using weighted polytomous regression. Follow-up hypertension odds also were compared in three pregnancy BP groups: normotensives (referent) and moderately elevated BP with or without PE-related placental/extraplacental membrane findings. MAIN OUTCOME MEASURES Stage 2 hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg, or using antihypertensive medications) at follow up. RESULTS After excluding women with pregnancy hypertension (i.e. chronic, PE, gestational), mural hyperplasia and unaltered/abnormal decidual vessels were each associated with Stage 2 hypertension at follow up: adjusted odds ratio (aOR) = 2.7, 95% CI 1.1-6.6, and aOR = 1.7 (95% CI 0.8-3.4), respectively. Women with moderately elevated BP in pregnancy and evidence of mural hyperplasia or unaltered/abnormal decidual vessels had greater odds of Stage 2 hypertension at follow up: aOR = 4.5 (95% CI 1.6-12.5 and aOR = 2.6, 95% CI 1.1-5.9, respectively. CONCLUSIONS PE-related placental/extraplacental membrane findings help risk-stratify women with moderately elevated BP in pregnancy for later development of hypertension. TWEETABLE ABSTRACT Placental findings associated with mother's risk of later-life hypertension.
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Affiliation(s)
- C B Holzman
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - P Senagore
- Emeritus, Michigan State University, East Lansing, MI, USA
| | - J Xu
- Medtronic, Inc., Minneapolis, MN, USA
| | - G L Dunietz
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - K L Strutz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, MI, USA
| | - Y Tian
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - B L Bullen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - M Eagle
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - J M Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA
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Scroggins SM, Gray G, Berkey C, Gandley RE, Sutton EF, Gemmel M, Brandt DS, Santillan DA, Pierce GL, Hubel CA, Catov JM, Santillan MK. Abstract 3: Preeclampsia-induced T Helper-associated Cytokine Imbalances Persist Postpartum. Hypertension 2020. [DOI: 10.1161/hyp.76.suppl_1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preeclampsia (PreE), a hypertensive disorder in pregnancy, contributes to long-term maternal cardiovascular disease risk. By 2025, it is estimated that more women than men will have hypertension (HTN), yet the mechanisms contributing to the development of HTN in women are less understood. One potential mechanism underlying HTN in women is a persistent imbalance of anti- and pro- inflammatory T
H
cells following PreE. Consistent with this, anti-inflammatory T helper (T
H
) cytokines are reduced and pro-inflammatory T
H
cytokines are increased during a PreE pregnancy.
De-identified and coded plasma samples and clinical data were obtained from the Magee-Women’s Research Institute & Foundation or the University of Iowa Maternal-Fetal Tissue Bank (IRB 201808705) from women 1-3 (N=93) or 8-10 (N=58) years (yrs) following a normotensive (CTL) or PreE-affected pregnancy. Postpartum (PP) HTN was defined as having stage 1 or higher HTN as designated in the updated 2017 ACC/AHA guidelines. Women with PreE had higher rates of HTN at 1-3 years and at 8-10 years PP, (24% vs. 5% and 65% vs. 17%, all p<0.05) compared to women with a normotensive pregnancy.
To determine if T
H
cells play a role in the future development of HTN, we investigated if the T
H
cytokine changes observed in PreE persist 1-3 yrs and 8-10 yrs PP. Cytokine concentrations were determined via ELISAs and normalized to total protein. Average cytokine concentrations are reported in pg/g. At 1-3 yrs PP, concentrations of anti-inflammatory cytokines IL-4 (47 vs. 6819, p<0.05), IL-10 (1204 vs. 15042, p<0.05) and TGFβ (8.2x10
5
vs. 4.4x10
6
, p<0.05) were reduced in women with a prior PreE pregnancy vs. women with a CTL pregnancy. At 8-10 yrs PP, pro-inflammatory IL-6 (86 vs. 18, p<0.05) and TNFα (298 vs. 53, p<0.05) were both significantly increased in women with prior PreE compared to women with a CTL pregnancy.
Here, we confirm women with a prior PreE pregnancy present with a higher prevalence of HTN early (1-3 yrs) and later (8-10 yrs) PP compared to women with a normotensive pregnancy. Further, we show an altered T
H
cytokine milieu persists following delivery in women with PreE. This pro-inflammatory milieu is associated with increased rates of HTN and thus, may underlie the future development of HTN in women with a history of PreE.
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Affiliation(s)
| | | | | | | | | | - Mary Gemmel
- Magee Women's Rsch Institute, Pittsburgh, PA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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48
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Sun B, Bertolet M, Brooks MM, Hubel CA, Lewis CE, Gunderson EP, Catov JM. Life Course Changes in Cardiometabolic Risk Factors Associated With Preterm Delivery: The 30-Year CARDIA Study. J Am Heart Assoc 2020; 9:e015900. [PMID: 32696706 PMCID: PMC7792274 DOI: 10.1161/jaha.119.015900] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Women who deliver preterm infants (<37 weeks) have excess cardiovascular risk; however, it is unclear whether the unfavorable changes in the cardiometabolic profile associated with preterm delivery initiate before, during, or after childbearing. Methods and Results We identified 1306 women (51% Black) with births between baseline (1985–1986) and year 30 in the CARDIA (Coronary Artery Risk Development in Young Adults) study. We compared life course changes in blood pressure, body mass index, waist circumference, and lipids in women with preterm deliveries (n=318) with those with all term deliveries (n=988), using piecewise linear mixed‐effects models. Specifically, we evaluated group differences in rates of change before and after the childbearing period and change in level across the childbearing period. After adjusting for the covariates, women with preterm deliveries had a higher change in diastolic blood pressure across the childbearing period than those with all term deliveries (1.59 versus −0.73 mm Hg, P<0.01); the rates of change did not differ by group, both prechildbearing and postchildbearing. Women with preterm deliveries had a larger body mass index increase across the childbearing period (1.66 versus 1.22 kg/m2, P=0.03) compared with those with all term deliveries, followed by a steeper increase after the childbearing period (0.22 versus 0.17 kg/m2 per year, P=0.02). Conclusions Preterm delivery was associated with unfavorable patterns of change in diastolic blood pressure and adiposity that originate during the childbearing years and persist or exacerbate later in life. These adverse changes may contribute to the elevated cardiovascular risk among women with preterm delivery.
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Affiliation(s)
- Baiyang Sun
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Marnie Bertolet
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Maria M Brooks
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Carl A Hubel
- Department of Obstetrics, Gynecology, and Reproductive Sciences University of Pittsburgh School of Medicine Pittsburgh PA.,Magee-Womens Research Institute Pittsburgh PA
| | - Cora E Lewis
- Department of Epidemiology University of Alabama at Birmingham AL
| | - Erica P Gunderson
- Division of Research Kaiser Permanente Northern California Oakland CA
| | - Janet M Catov
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA.,Department of Obstetrics, Gynecology, and Reproductive Sciences University of Pittsburgh School of Medicine Pittsburgh PA.,Magee-Womens Research Institute Pittsburgh PA
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49
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Monk C, Webster RS, McNeil RB, Parker CB, Catov JM, Greenland P, Bairey-Merz CN, Silver RM, Simhan HN, Ehrenthal DB, Chung JH, Haas DM, Mercer BM, Parry S, Polito L, Reddy UM, Saade GR, Grobman WA. Associations of perceived prenatal stress and adverse pregnancy outcomes with perceived stress years after delivery. Arch Womens Ment Health 2020; 23:361-369. [PMID: 31256258 PMCID: PMC6935433 DOI: 10.1007/s00737-019-00970-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023]
Abstract
Maternal stress is a risk factor for adverse pregnancy outcomes (APOs). This study evaluates the associations of prenatal stress and APOs with maternal stress years after pregnancy. The 10-item Perceived Stress Scale (PSS) (0-40 range) was completed in the first and third trimesters, and 2-7 years after delivery among a subsample (n = 4161) of nulliparous women enrolled at eight US medical centers between 2010 and 2013 in a prospective, observational cohort study. Demographics, medical history, and presence of APOs (gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preeclampsia (PE), and medically indicated or spontaneous preterm birth (miPTB, sPTB)) were obtained. The associations of prenatal PSS and the presence of APOs with PSS scores years after delivery were estimated using multivariable linear regression. Mean PSS scores were 12.5 (95% CI 12.3, 12.7) and 11.3 (95% CI 11.1, 11.5) in the first and third trimesters respectively and 14.9 (95% CI 14.7, 15.1) 2-7 years later, an average increase of 2.4 points (95% CI 2.2, 2.6) from the start of pregnancy. Regressing PSS scores after delivery on first-trimester PSS and PSS increase through pregnancy showed positive associations, with coefficients (95% CI) of 2.8 (2.7, 3.0) and 1.5 (1.3, 1.7) per 5-point change, respectively. Adding APO indicator variables separately showed higher PSS scores for women with HDP (0.7 [0.1, 1.3]), PE (1.3 [0.6, 2.1]), and miPTB (1.3 [0.2, 2.4]), but not those with GDM or sPTB. In this geographically and demographically diverse sample, prenatal stress and some APOs were positively associated with stress levels 2-7 years after pregnancy.ClinicalTrials.gov Registration number NCT02231398.
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Affiliation(s)
- Catherine Monk
- Departments of Psychiatry and Obstetrics and Gynecology, Columbia University, 630 West 168th Street, PH1540H, New York, NY, 10032, USA.
| | - Rachel S. Webster
- Columbia University Vagelos College of Physicians and
Surgeons, New York, New York
| | | | | | - Janet M. Catov
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip Greenland
- Division of Cardiology, Department of Medicine,
Northwestern University, Chicago, Illinois
| | - C. Noel Bairey-Merz
- Division of Cardiology, Department of Medicine,
Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah
and Intermountain Healthcare, Salt Lake City, Utah
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of
California, Irvine, California
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of
Medicine, Indiana University, Indianapolis, Indiana
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, Case Western
Reserve University, Cleveland, Ohio
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - LuAnn Polito
- Department of Obstetrics and Gynecology, Case Western
Reserve University, Cleveland, Ohio
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health
and Human Development, Bethesda, Maryland
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of
Texas Medical Branch, University of Texas, Galveston, Texas
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Northwestern
University, Chicago, Illinois
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50
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Lane-Cordova AD, Gunderson EP, Greenland P, Catov JM, Lewis CE, Pettee Gabriel K, Wellons MF, Carnethon MR. Life-Course Reproductive History and Cardiovascular Risk Profile in Late Mid-Life: The CARDIA Study. J Am Heart Assoc 2020; 9:e014859. [PMID: 32366209 PMCID: PMC7660840 DOI: 10.1161/jaha.119.014859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Reproductive events, that is, a preterm birth (PTB), small‐for‐gestational‐age infant (SGA), and vasomotor symptoms of menopause, are associated with subclinical atherosclerotic cardiovascular disease (ASCVD). We evaluated whether women with a past PTB and/or SGA (henceforth PTB/SGA) were more likely to have severe vasomotor symptoms of menopause and whether the estimated 10‐year ASCVD risk was higher in women with PTB/SGA and vasomotor exposures. Methods and Results We assigned 1866 women (mean age=55±1 years) in the CARDIA (Coronary Artery Risk Development in Young Adults) study to the following categories of reproductive exposures: none, PTB/SGA only, vasomotor symptoms only, or both PTB/SGA and vasomotor symptoms. We used Kruskal‐Wallis tests to evaluate the differences in pooled cohort equation ASCVD risk scores by category and linear regression to evaluate the associations of categories with ASCVD risk scores adjusted for study center, body mass index, education, current hormone replacement therapy use, parity, and hysterectomy. Women with PTB/SGA were more likely to have severe vasomotor symptoms, 36% versus 30%, P<0.02. ASCVD risk score was higher in women with both PTB/SGA and vasomotor symptoms (4.6%; 95% CI, 4.1%–5.1%) versus women with no exposures (3.3%; 95% CI, 2.9%–3.7%) or vasomotor symptoms only (3.8%; 95% CI, 3.5%–4.0%). ASCVD risk score was higher in women PTB/SGA (4.8%; 95% CI, 3.6%–5.9%) versus no exposures. PTB/SGA and vasomotor symptoms was associated with ASCVD risk score in white women versus no exposures (β=0.40; 95% CI, 0.02–0.78). Conclusions Women with prior PTB/SGA were more likely to have severe vasomotor symptoms of menopause. Reproductive exposures were associated with an estimated 10‐year ASCVD risk in white women.
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Affiliation(s)
| | - Erica P Gunderson
- Division of Research Kaiser Permanente Northern California Oakland CA
| | - Philip Greenland
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Janet M Catov
- Magee-Women's Research Institute and Department of Epidemiology University of Pittsburgh Pittsburgh, PA
| | - Cora E Lewis
- Division of Preventive Medicine University of Alabama at Birmingham Birmingham, AL
| | | | | | - Mercedes R Carnethon
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
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