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Vascular remodeling associated with pregnancy

Niemczyk, Nancy A. (2015) Vascular remodeling associated with pregnancy. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Objectives: Research indicates a relationship between pregnancy and cardiovascular disease, but the cause of this relationship is unknown. One possible explanation is that there is a relationship between pregnancy and vascular change. The objective of this dissertation is to illuminate this relationship by exploring 1) the association between parity and structure of the carotid arteries in a population of overweight or obese women of reproductive age and 2) the normal course of common carotid artery (CCA) remodeling and changes in stiffness of the brachial artery throughout a healthy first pregnancy and postpartum.
Methods: The first paper provides a cross-sectional analysis of the relationship between reproductive factors and structural measures of the carotid artery in overweight and obese young women participating in the Slow Adverse Vascular Effect of Obesity (SAVE) clinical trial. The subsequent 2 papers provide results of the Maternal Vascular Adaptation to Healthy Pregnancy (MVP) study, in which 43 healthy young women were assessed prospectively throughout their first pregnancies with ultrasounds of their carotid arteries, a measure of brachial artery distensibility, and physical and metabolic measures.
Results: In the SAVE study, nulliparous women had greater common carotid inter-adventitial diameter (IAD) and mean CCA intima media thickness (IMT) compared with parous women
after adjustment for age, race, and CVD risk factors. In the MVP study, after adjustment for age and pre-pregnancy BMI, mean IAD increased each trimester and returned to baseline postpartum. Mean CCA IMT was increased postpartum compared to 1st and 2nd trimester values. Mean brachial artery distensibility decreased from 1st trimester to 3rd trimester and then remained unchanged postpartum.
Conclusions: Among overweight and obese young women, nulliparity was associated with less healthy carotid arteries. During the course of healthy first pregnancy, some negative vascular changes (greater CCA IMT and stiffer brachial arteries) occurred that persisted into the postpartum period.
Public Health Significance: Cardiovascular disease is the leading cause of death in women. Early identification of women at high risk (nulliparous) offers early opportunity for risk reduction. Understanding normal vascular changes of pregnancy may help explain the pathophysiology of preeclampsia, the cause of 50,000 maternal deaths per year.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Niemczyk, Nancy A.nan37@pitt.eduNAN37
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBarina-Mitchell, Emmabarinas@edc.pitt.eduEJB4
Committee MemberCatov, Janetcatovjm@mail.magee.edu
Committee MemberRoberts, James M.robertsjm@mwri.magee.edu
Committee MemberSekikawa, Akiraakira@pitt.eduAKIRA
Committee MemberTepper, Ping G.tepperp@edc.pitt.eduPTEPPER
Date: 28 January 2015
Date Type: Publication
Defense Date: 2 December 2014
Approval Date: 28 January 2015
Submission Date: 25 November 2014
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 138
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Vascular remodeling Parity
Date Deposited: 28 Jan 2015 16:50
Last Modified: 01 Jan 2017 06:15
URI: http://d-scholarship.pitt.edu/id/eprint/23644

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