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(Unpublished)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