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The Role of Neighborhood Greenspace in reducing Risk of Hypertensive Disorders of Pregnancy, Chronic Hypertension, and Racial Disparities in Maternal Morbidity

Award Number: R01HL157160
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality and morbidity in the US, particularly for Black patients who are at greatest risk of poor outcomes. In addition to contributions to maternal mortality, HDP increase the risk of chronic hypertension (cHTN), which can lead to cardiovascular (CV) disease. Our parent grant (R01HL157160) is focused on neighborhood greenspace and its impact on HDP and subsequent cHTN using observational and experimental methods. The objective of this supplement proposal is to add crucial variables relevant to climate change and health (CCH) to this project. We will bring Dr. Allan Just onto our team to add temperature and air pollution, specifically particulate matter <2.5µm in diameter (PM2.5) to GeoBirth which is the cohort on which our parent project is based. GeoBirth includes 116,000 pregnant patients who gave birth in two Philadelphia hospitals from 2008 to present. We will analyze the 89,827 Philadelphia residents who gave birth from 2008-2020. Our overarching hypothesis is that extreme heat and elevated PM2.5 exposure contribute to the risks of, and racial disparities in, HDP and cHTN after pregnancy. We propose the following aims: 1) Observational: Quantify associations of extreme heat with HDP and cHTN after pregnancy and determine the extent to which heat mediates racial disparities in these outcomes. We will analyze associations of extreme heat with risk of HDP using multilevel logistic regression adjusted for individual and neighborhood-level confounders (1a). We will determine if extreme heat exposure is associated with risk of cHTN within 5 years after pregnancy using survival analysis methods (1b). We will quantify the extent to which extreme heat exposure among Black patients contributes to Black-White HDP and cHTN disparities using causal mediation and interaction analyses (1c). 2) Observational: Quantify associations of PM2.5 with HDP and cHTN after pregnancy and determine the extent to which PM2.5 mediates racial disparities in these outcomes. We will perform analogous analyses to Aim 1, using trimester-specific PM2.5 exposure in lieu of temperature. 3) Experimental: Determine the extent to which vacant lot greening mitigates exposure to extreme heat. We will also use data from a completed cluster RCT (2011-2014) to examine the impact of greening on ambient temperature in neighborhoods with clusters of 541 vacant lots in three trial conditions: greened; trash clean-up only; and control. This study will advance the field of women's CVD research by addressing the impact of climate change-related exposures to HDP and cHTN that lead to disproportionately high rates of mortality among Black patients. Our findings will inform individual-level clinical prevention efforts of CVD through personal exposure reduction in addition to large-scale urban policy changes to mitigate heat and pollution exposures.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $710,556 )
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	002	3	6/26/2024	NON-COMPETING CONTINUATION	$58,004
2024	2024	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	001	3	1/2/2024	NON-COMPETING CONTINUATION	$652,552
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	003	2	6/27/2024	SUPPLEMENT FOR EXPANSION	$0
2024	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	000	2	10/11/2023	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $710,556

Issue Date FY: 2023 ( Subtotal = $1,235,973 )
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	002	2	8/21/2023	SUPPLEMENT FOR EXPANSION	$499,609
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	000	2	12/8/2022	NON-COMPETING CONTINUATION	$662,727
2023	2023	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	001	2	3/8/2023	NON-COMPETING CONTINUATION	$73,637
														Subtotal = $1,235,973

Issue Date FY: 2022 ( Subtotal = $778,937 )
2022	2022	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE	3451 WALNUT ST STE 440A	PHILADELPHIA	PA	19104	PHILADELPHIA	USA	Cardiovascular Diseases Research	000	1	1/3/2022	NEW	$778,937
														Subtotal = $778,937

Grand Total All Awards = $2,725,466

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The Role of Neighborhood Greenspace in reducing Risk of Hypertensive Disorders of Pregnancy, Chronic Hypertension, and Racial Disparities in Maternal Morbidity

Award Number: R01HL157160

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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