Arterial stiffness in mother/infant dyads: Life course approach to prevent cardiovascular disease - ABSTRACT
Cardiovascular disease (CVD) is the leading cause of death for U.S women, annually killing >400,000 women.
Compared to whites, non-Hispanic Black and Latina women are at higher CVD risk. Despite the burden of CVD
in women, risk factors specific to women are understudied and thus not considered in current CVD risk
prediction or prevention strategies. Early detection of subclinical disease is key to CVD risk stratification and
prevention. Since prenatal and postpartum care is the sole health care access point for most U.S. women,
pregnancy represents a critical opportunity to measure CVD risk and implement innovative strategies to
address this critical gap in women’s health care. Furthermore, CVD risk factor trajectories begin in utero and in
early life, so pregnancy is also an opportunity to identify CVD risk in children. Our long-range goal is to
identify and disseminate obstetric care practices that mitigate CVD risk for women and their children. The
objective of this prospective, multicenter study is to estimate CVD risk in healthy and medically complicated
pregnant women and their infants. We will also examine the relationships among personal, social, and
ecological factors and CVD risk for 3 years postpartum. Our primary outcomes are maternal and infant
central pulse wave velocity (PWV), a validated measure of arterial stiffness (vascular aging) that predicts CVD,
independent of other established CVD risk factors. We will enroll a cohort 840 pregnant women of diverse
race/ethnicity and socioeconomic status: 420 healthy and 420 women with preeclampsia, gestational diabetes,
and/or suspected fetal growth restriction. We will measure maternal and infant PWV, cardio-metabolic (e.g.,
blood pressure, lipids, adiposity, HbA1c) and inflammatory (e.g., hs-CRP, IL-6, adiponectin) markers of CVD
risk, and assess personal, social, and ecological factors at 34-40 weeks’ gestation, delivery, 6 months, 18
months, and 3 years. The study aims are the following: 1) Measure arterial stiffness by PWV during and after
pregnancy; 2) Measure infant/child PWV following healthy and complicated pregnancies; and 3)
Identify maternal and infant modifiable risk factors associated with CVD risk measured by PWV. To date, no
studies have longitudinally measured CVD risk in pregnant women and their infants, nor ascertained the effect
of biologic, personal, social, and/or ecological factors on CVD risk. Using a noninvasive measure of arterial
stiffness, we propose to determine CVD risk in a cohort of mother-infant dyads. Our interdisciplinary study
team of experts in CVD, high-risk pregnancy, exercise and sports physiology, CVD epidemiology, public
health, and cardiology are well poised to complete the proposed aims by using a synthesis of expertise to
achieve our common, shared goal of mitigate CVD risk for women and their children. We are proposing an
innovative paradigm shift in the goals of prenatal care to use pregnancy as a time in a woman’s life, particularly
if she is at high risk for CVD, to identify and mitigate early markers of CVD for herself and her offspring.
