Carpio, Kharlya
(2025)
Measuring the effects of social, physical, and chemical environments in pregnancy: a biomarker approach to reduce disparities in maternal cardiovascular health.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
This dissertation develops a framework for measuring the placenta as a critical link between environmental exposures and maternal health, with implications for long-term maternal cardiovascular outcomes and the Black-White disparities in these outcomes in the U.S.
In Chapter 2, we establish a foundation by validating molecular approaches to measure placental tissue biomarkers, and their associations with circulating markers. We quantify placental RNA and protein biomarkers and evaluate biologic and technical sources of variability. Validation of circulating biomarkers with their corollaries measured in placental tissue confirm that what we have measured is predominantly placental in origin, rather than maternal or fetal.
Building on this work, Chapter 3 integrates circulating maternal-placental biomarkers with self-reported measures across three maternal environment domains: social and psychosocial, physical, and chemical. Focusing on the placental hormone human chorionic gonadotropin (hCG), we examine associations with stress exposures at four pregnancy timepoints and the postpartum period. We identified the first trimester as a sensitive period for maternal-placental stress, and found associations between neighborhood stress measures (e.g., food environment and green spaces) and biomarkers at all timepoints. This work positions the placenta as central to “prenatal maternal programming” and adds to the growing recognition of pregnancy as a critical window from which we can glean insights into future maternal cardiovascular health.
In Chapter 4, we extend this research into the neighborhood level by identifying a real-world intervention to increase tree canopy coverage. Using the target trial framework, we estimate the potential impact of the intervention on reducing the Black-White disparity in preeclampsia. While causal estimates cannot be obtained, this work points to the importance of shifting focus upstream from individual stress and pregnancy physiology to structural determinants. Greenery was selected for its ongoing evaluation in neighborhood effects research, representing a realistic, scalable intervention with the potential to inform public policy.
We conclude that accurate and precise measurement of placental tissue biomarkers can represent underlying molecular pathways in pregnancy that are altered by the maternal environment. Pilot work to refine measurement strategy and theory building are essential components in my long-term goal to prevent causes of disparities in maternal cardiovascular outcomes.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
7 January 2025 |
| Date Type: |
Publication |
| Defense Date: |
10 December 2024 |
| Approval Date: |
7 January 2025 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
200 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Date Deposited: |
07 Jan 2025 14:12 |
| Last Modified: |
07 Jan 2025 14:12 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/47282 |
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