1
00:00:06,296 --> 00:00:07,531
>> GOOD AFTERNOON.

2
00:00:07,531 --> 00:00:10,901
MY NAME IS DR. CANDICE PRICE,

3
00:00:10,901 --> 00:00:12,936
AND I AM A PROGRAM DIRECTOR AT

4
00:00:12,936 --> 00:00:14,738
THE NATIONAL HEART, LUNG AND

5
00:00:14,738 --> 00:00:16,707
BLOOD INSTITUTE AT NIH.

6
00:00:16,707 --> 00:00:19,776
ON BEHALF OF THE NHLBI OBESITY

7
00:00:19,776 --> 00:00:21,311
WORKING GROUP, I'M EXCITED TO

8
00:00:21,311 --> 00:00:23,613
SERVE AS THE MODERATOR FOR THIS

9
00:00:23,613 --> 00:00:26,984
18TH OBESITY, NUTRITION AND

10
00:00:26,984 --> 00:00:28,318
PHYSICAL ACTIVITY SEMINAR.

11
00:00:28,318 --> 00:00:29,386
PAST PRESENTATIONS HAVE

12
00:00:29,386 --> 00:00:31,054
HIGHLIGHTED A VARIETY OF TOPICS

13
00:00:31,054 --> 00:00:33,023
SUCH AS TECHNOLOGY ASSISTED INTD

14
00:00:33,023 --> 00:00:35,625
VENGSES FOR WEIGHT MANAGEMENT,

15
00:00:35,625 --> 00:00:36,760
FOOD INSECURITY AND COVID-19,

16
00:00:36,760 --> 00:00:40,464
THE ROLE OF TEACHING KITCHENS IN

17
00:00:40,464 --> 00:00:41,098
ADDRESSING NUTRITION

18
00:00:41,098 --> 00:00:42,399
DISPARITIES, HOW TO IMPROVE FOOD

19
00:00:42,399 --> 00:00:43,967
ACCESS AND OBESITY IN BALTIMORE,

20
00:00:43,967 --> 00:00:46,803
THE RELATIONSHIP BETWEEN BODY

21
00:00:46,803 --> 00:00:48,772
WEIGHT, AND CARDIOVASCULAR RISK

22
00:00:48,772 --> 00:00:50,607
AMONG SOUTH ASIAN AMERICANS AND

23
00:00:50,607 --> 00:00:52,642
MOST RECENTLY, DIETARY

24
00:00:52,642 --> 00:00:55,212
BIOMARKERS TO IDENTIFY THE

25
00:00:55,212 --> 00:00:56,079
CARDIOPROTECTIVE MECHANISMS OF

26
00:00:56,079 --> 00:00:58,582
THE DASH DIE E TODAY'S

27
00:00:58,582 --> 00:01:00,884
PRESENTATION BY DR. SADIYA KHAN

28
00:01:00,884 --> 00:01:02,919
IS ENTITLED CARDIOVASCULAR

29
00:01:02,919 --> 00:01:06,256
HEALTH IN THE PERIPARTUM PERIOD,

30
00:01:06,256 --> 00:01:11,361
DRIVERS AND DETERMINANTS.

31
00:01:11,361 --> 00:01:12,696
BEFORE WE START I WANT TO REVIEW

32
00:01:12,696 --> 00:01:16,500
A FEW HOUSEKEEPING ITEMS.

33
00:01:16,500 --> 00:01:17,300
THROUGHOUT THE PRESENTATION AND

34
00:01:17,300 --> 00:01:18,368
Q & A DISCUSSION, PLEASE
SEND

35
00:01:18,368 --> 00:01:21,204
ANY QUESTIONS TO THE EMAIL

36
00:01:21,204 --> 00:01:26,977
ADDRESS LISTED ON THE SLIDES.

37
00:01:26,977 --> 00:01:28,311
ONPA@MAIL.NIH.GOV.

38
00:01:28,311 --> 00:01:30,013
OR CLICK ON THE LIVE FEEDBACK AT

39
00:01:30,013 --> 00:01:31,681
THE BOTTOM OF THE VIDEOCAST

40
00:01:31,681 --> 00:01:33,116
SCREEN TO SUBMIT A QUESTION OR

41
00:01:33,116 --> 00:01:34,851
COMMENT.

42
00:01:34,851 --> 00:01:40,791
NOW LET'S INTRODUCE OUR SPEAKER.

43
00:01:40,791 --> 00:01:43,260
DR. SADIYA KHAN IS THE PROFESSOR

44
00:01:43,260 --> 00:01:46,463
OF CARDIOVASCULAR EPIDEMIOLOGY

45
00:01:46,463 --> 00:01:47,464
AND TENURED ASSOCIATE PROFESSOR

46
00:01:47,464 --> 00:01:50,834
OF MEDICINE AND PREVENTIVE

47
00:01:50,834 --> 00:01:52,369
MEDICINE AND DIRECTOR OF THE

48
00:01:52,369 --> 00:01:55,972
CENTER OF POPULATION SCIENCE AND

49
00:01:55,972 --> 00:01:56,973
AGING IN THE LONGEVITY

50
00:01:56,973 --> 00:01:58,442
INSTITUTE.

51
00:01:58,442 --> 00:02:02,112
AND SHE IS A PREVENTIVE

52
00:02:02,112 --> 00:02:03,613
CARDIOLOGIST AT THE NORTD

53
00:02:03,613 --> 00:02:05,549
WESTERN UNIVERSITY FEINBERG

54
00:02:05,549 --> 00:02:07,284
SCHOOL OF MEDICINE.

55
00:02:07,284 --> 00:02:09,152
DR. KHAN'S CLINICAL EXPERTISE

56
00:02:09,152 --> 00:02:12,155
AND RESEARCH FOCUS ON THE

57
00:02:12,155 --> 00:02:13,256
EPIDEMIOLOGY, PREDICTION AND

58
00:02:13,256 --> 00:02:14,458
GENETICS OF CARDIOVASCULAR

59
00:02:14,458 --> 00:02:16,159
DISEASE WITH A FOCUS ON

60
00:02:16,159 --> 00:02:17,994
PREGNANCY-SPECIFIC RISK FACTORS.

61
00:02:17,994 --> 00:02:19,596
DR. KHAN'S RESEARCH EFFORTS ARE

62
00:02:19,596 --> 00:02:20,931
SUPPORTED BY THE MULTIPLE GRANTS

63
00:02:20,931 --> 00:02:22,399
FROM THE NATIONAL INSTITUTES OF

64
00:02:22,399 --> 00:02:23,967
HEALTH AND THE AMERICAN HEART

65
00:02:23,967 --> 00:02:25,402
ASSOCIATION.

66
00:02:25,402 --> 00:02:27,304
DR. KHAN HAS PUBLISHED OVER 300

67
00:02:27,304 --> 00:02:28,705
PEER REVIEWED SCIENTIFIC

68
00:02:28,705 --> 00:02:30,440
RESEARCH PUBLICATIONS IN LEADING

69
00:02:30,440 --> 00:02:32,509
MEDICAL JOURNALS AND HAS AN H

70
00:02:32,509 --> 00:02:38,315
INDEX OF 41 AS JANUARY OF 2024.

71
00:02:38,315 --> 00:02:40,383
HER ORIGINAL SCIENCE HAS BEEN

72
00:02:40,383 --> 00:02:41,151
HIGHLIGHTED BY THE AMERICAN

73
00:02:41,151 --> 00:02:43,019
HEART ASSOCIATION AS AMONG THE

74
00:02:43,019 --> 00:02:44,454
TOP ADVANCES IN HEART DISEASE

75
00:02:44,454 --> 00:02:46,623
AND STROKE RESEARCH FOR FOUR

76
00:02:46,623 --> 00:02:48,892
CONSECUTIVE YEARS FROM 2020 TO

77
00:02:48,892 --> 00:02:50,460
2023.

78
00:02:50,460 --> 00:02:52,662
WELCOME, DR. KHAN.

79
00:02:52,662 --> 00:02:54,297
>> THANK YOU SO MUCH, DR.
PRICE,

80
00:02:54,297 --> 00:02:56,032
FOR THAT KIND INTRODUCTION AND

81
00:02:56,032 --> 00:02:59,636
FOR THE OPPORTUNITY TO --

82
00:02:59,636 --> 00:03:01,304
YOURSELF AND THE ORGANIZERS TO

83
00:03:01,304 --> 00:03:04,441
PRESENT TODAY.

84
00:03:04,441 --> 00:03:08,044
I HAVE NO RELATIONSHIPS WITH

85
00:03:08,044 --> 00:03:10,480
INDUSTRY AND FUNDING AS NOTED.

86
00:03:10,480 --> 00:03:12,415
SO I WANTED TO START WITH A CASE

87
00:03:12,415 --> 00:03:13,750
PRESENTATION TO SET THE STAGE OF

88
00:03:13,750 --> 00:03:15,385
WHAT WE'RE REALLY TALKING ABOUT

89
00:03:15,385 --> 00:03:17,287
IN TERMS OF CARDIOVASCULAR

90
00:03:17,287 --> 00:03:18,889
HEALTH IN THE PERIPARTUM PERIOD,

91
00:03:18,889 --> 00:03:20,423
AND HOW WE DEFINE IT AND THINK

92
00:03:20,423 --> 00:03:21,291
ABOUT IT.

93
00:03:21,291 --> 00:03:22,859
THIS WAS A PATIENT THAT I SAW A

94
00:03:22,859 --> 00:03:25,328
COUPLE OF YEARS AGO WHO'S 27,

95
00:03:25,328 --> 00:03:27,197
HAD HAD AN UNCOMPLICATED

96
00:03:27,197 --> 00:03:29,833
DELIVERY, AND PRESENTED TO THE

97
00:03:29,833 --> 00:03:30,934
HOSPITAL FIVE DAYS POSTPARTUM

98
00:03:30,934 --> 00:03:32,335
WITH ACUTE SHORTNESS OF BREATH.

99
00:03:32,335 --> 00:03:35,172
HER HEART RATE WAS 90, SHE WAS

100
00:03:35,172 --> 00:03:39,676
HYPERTENSIVE, SHE HAD ELEVATED

101
00:03:39,676 --> 00:03:43,046
JUGULAR VENOUS PRESSURE AND

102
00:03:43,046 --> 00:03:44,581
CHEST X-RAY SHOWN HERE THAT

103
00:03:44,581 --> 00:03:46,483
DEMONSTRATED ACUTE VOLUME

104
00:03:46,483 --> 00:03:48,518
OVERLOAD SO CONSISTENT WITH

105
00:03:48,518 --> 00:03:50,587
ACUTE HEART FAILURE

106
00:03:50,587 --> 00:03:51,021
EXACERBATION.

107
00:03:51,021 --> 00:03:54,558
HER BIOMARKERS WERE CHECKED.

108
00:03:54,558 --> 00:03:59,796
ELEVATED AT 1100 AND TROPONIN

109
00:03:59,796 --> 00:04:02,199
ELEVATED AT 2.5.

110
00:04:02,199 --> 00:04:04,301
WE OBTAINED AN ECHOCARDIOGRAM

111
00:04:04,301 --> 00:04:05,802
THAT DEMONSTRATED OVERALL

112
00:04:05,802 --> 00:04:07,571
PRESERVED EJECTION FRACTION

113
00:04:07,571 --> 00:04:11,007
GIVEN OUR CONCERN FOR PERIPARTUM

114
00:04:11,007 --> 00:04:12,042
CARDIOMYOPATHY BUT THERE WAS A

115
00:04:12,042 --> 00:04:17,080
BIT OF INFRALATERAL HIGH

116
00:04:17,080 --> 00:04:19,382
COKINESIS, OVERALL A PICTURE

117
00:04:19,382 --> 00:04:21,218
CONSISTENT WITH POSTPARTUM

118
00:04:21,218 --> 00:04:22,719
PRE-ECLAMPSIA THIS REALLY LED TO

119
00:04:22,719 --> 00:04:24,721
TWO KEY QUESTIONS THAT BY THE

120
00:04:24,721 --> 00:04:26,256
END OF THIS PRESENTATION,

121
00:04:26,256 --> 00:04:27,691
HOPEFULLY WE'LL BE ABLE TO

122
00:04:27,691 --> 00:04:28,458
ADDRESS.

123
00:04:28,458 --> 00:04:30,760
FIRST, WHAT SHOULD WE COUNSEL

124
00:04:30,760 --> 00:04:32,262
THIS PATIENT ON HER SHORT TERM

125
00:04:32,262 --> 00:04:33,897
AND LONG TERM RISK OF

126
00:04:33,897 --> 00:04:35,565
CARDIOVASCULAR DISEASE, AND TO

127
00:04:35,565 --> 00:04:37,033
FOLLOW THAT UP, WHAT EVIDENCE

128
00:04:37,033 --> 00:04:39,069
HAD BEEN BASED STRATEGIES EXIST

129
00:04:39,069 --> 00:04:43,106
TO REDUCE CARD JOE VASCULAR

130
00:04:43,106 --> 00:04:44,975
DISEASE IN THE PERIPARTUM PERIOD

131
00:04:44,975 --> 00:04:46,843
AND WE'LL COVER THESE WITH SOME

132
00:04:46,843 --> 00:04:47,711
KEY OBJECTIVES IN THE NEXT

133
00:04:47,711 --> 00:04:48,011
SLIDE.

134
00:04:48,011 --> 00:04:54,384
SO HOW DO HE WITHEST WE ANSWER R

135
00:04:54,384 --> 00:04:55,752
AND MANY MORE LIKE LER?

136
00:04:55,752 --> 00:04:56,920
LET'S THINK IN THREE STEPS OVER

137
00:04:56,920 --> 00:04:58,788
THE NEXT 40 MINUTES OR SO.

138
00:04:58,788 --> 00:05:00,457
FIRST, REALLY TRYING TO CLARIFY

139
00:05:00,457 --> 00:05:02,525
WHAT IS THE PERIPARTUM PERIOD

140
00:05:02,525 --> 00:05:04,594
AND WHY IS IT CRITICAL FOR

141
00:05:04,594 --> 00:05:06,596
CARDIOVASCULAR DISEASE RISK IN

142
00:05:06,596 --> 00:05:07,764
BIRTHING INDIVIDUALS?

143
00:05:07,764 --> 00:05:09,499
NEXT, WE'LL DESCRIBE THE

144
00:05:09,499 --> 00:05:10,500
EPIDEMIOLOGY OF ADVERSE

145
00:05:10,500 --> 00:05:12,235
PREGNANCY OUTCOMES AND LOOK TO

146
00:05:12,235 --> 00:05:13,470
SOME OF THE DRIVERS OF THESE

147
00:05:13,470 --> 00:05:15,205
TRENDS.

148
00:05:15,205 --> 00:05:16,940
AND THIRD, DISCUSS THE RATIONALE

149
00:05:16,940 --> 00:05:18,575
FOR CARDIOVASCULAR HEALTH

150
00:05:18,575 --> 00:05:19,809
PROMOTION IN IDENTIFYING

151
00:05:19,809 --> 00:05:21,444
OPPORTUNITIES TO INTERVENE IN

152
00:05:21,444 --> 00:05:25,482
THE PERIPARTUM PERIOD.

153
00:05:25,482 --> 00:05:28,551
SO LET'S GET STARTED WITH THE

154
00:05:28,551 --> 00:05:29,352
PERIPARTUM PERIOD WITHIN THE

155
00:05:29,352 --> 00:05:30,520
CONSTRUCT OF A LIFE COURSE

156
00:05:30,520 --> 00:05:34,224
APPROACH.

157
00:05:34,224 --> 00:05:35,759
IF WE THINK ABOUT THE OVERALL

158
00:05:35,759 --> 00:05:36,860
FEMALE LIFE COURSE AND WE GO TO

159
00:05:36,860 --> 00:05:38,628
THE NEXT SLIDE, WE'LL ZERO IN ON

160
00:05:38,628 --> 00:05:40,897
THE REPRODUCTIVE LIFE COURSE.

161
00:05:40,897 --> 00:05:42,432
IF WE ADVANCE ONE FURTHER, WE'LL

162
00:05:42,432 --> 00:05:44,534
THINK ABOUT THIS ENTIRE PERIOD

163
00:05:44,534 --> 00:05:47,037
AS BEGINNING IN MENARCHE AND

164
00:05:47,037 --> 00:05:48,905
ENDING IN MENOPAUSE IN WHICH AN

165
00:05:48,905 --> 00:05:50,140
INDIVIDUAL WHO IS

166
00:05:50,140 --> 00:05:50,774
PREGNANCY-CAPABLE MAY HAVE ONE

167
00:05:50,774 --> 00:05:52,275
OR MORE PREGNANCIES DURING THIS

168
00:05:52,275 --> 00:05:55,545
TIME PERIOD.

169
00:05:55,545 --> 00:05:57,314
THIS COLLECTIVELY COULD BE

170
00:05:57,314 --> 00:05:58,948
THOUGHT OF AS THE PREPREGNANCY,

171
00:05:58,948 --> 00:06:00,850
PREGNANCY AND POSTPARTUM PERIOD,

172
00:06:00,850 --> 00:06:02,452
WHICH TOGETHER IN AGGREGATE

173
00:06:02,452 --> 00:06:04,120
REPRESENT THE PERIPARTUM PERIOD.

174
00:06:04,120 --> 00:06:05,622
WHICH IS THE FOCUS OF THIS

175
00:06:05,622 --> 00:06:09,125
DISCUSSION.

176
00:06:09,125 --> 00:06:10,894
AS WE THINK ABOUT THIS, LET'S

177
00:06:10,894 --> 00:06:12,529
TAKE THE RIGHT SIDE OF THIS

178
00:06:12,529 --> 00:06:14,597
FIGURE FIRST AND TALK MORE ABOUT

179
00:06:14,597 --> 00:06:16,232
PREGNANCY AND POSTPARTUM WHERE

180
00:06:16,232 --> 00:06:18,101
THERE'S A LOT MORE DATA AND

181
00:06:18,101 --> 00:06:19,169
AWARENESS AROUND ADVERSE

182
00:06:19,169 --> 00:06:20,837
PREGNANCY OUTCOMES IN

183
00:06:20,837 --> 00:06:21,838
CARDIOVASCULAR DISEASE RISK.

184
00:06:21,838 --> 00:06:24,007
SO THAT SHORT TERM PERIOD WHERE

185
00:06:24,007 --> 00:06:25,208
MATERNAL MORBIDITY AND MORTALITY

186
00:06:25,208 --> 00:06:27,911
MAY BE PRESENT, INCLUDING ICU

187
00:06:27,911 --> 00:06:29,279
ADMISSIONS, MORBIDITY,

188
00:06:29,279 --> 00:06:30,547
MORTALITY, ADVERSE PREGNANCY

189
00:06:30,547 --> 00:06:32,849
OUTCOMES, AND HOW IT AFFECT

190
00:06:32,849 --> 00:06:33,850
LONG-TERM MORBIDITY AND

191
00:06:33,850 --> 00:06:36,586
MORTALITY.

192
00:06:36,586 --> 00:06:39,422
IF WE THINK ABOUT PREGNANCY AS A

193
00:06:39,422 --> 00:06:40,724
STRESS TEST, AS IT'S BEEN

194
00:06:40,724 --> 00:06:42,859
COMMONLY CALLED, WE HAVE TO

195
00:06:42,859 --> 00:06:44,060
FIRST UNDERSTAND THAT PREGNANCY

196
00:06:44,060 --> 00:06:47,864
IN AND OF ITSELF LEADS TO MANY

197
00:06:47,864 --> 00:06:49,165
PHYSIOLOGIC VASCULAR AND

198
00:06:49,165 --> 00:06:51,000
METABOLIC CHANGES THAT ARE

199
00:06:51,000 --> 00:06:52,435
APPROPRIATE ADAPTATIONS TO

200
00:06:52,435 --> 00:06:57,040
ACCOUNT FOR THE GROWING FETUS.

201
00:06:57,040 --> 00:06:59,209
UNFORTUNATELY, WHEN THOSE

202
00:06:59,209 --> 00:07:00,977
ADAPTATIONS RESULT IN

203
00:07:00,977 --> 00:07:02,512
PATHOPHYSIOLOGIC CONDITIONS, OR

204
00:07:02,512 --> 00:07:03,713
ADVERSE PREGNANCY OUTCOMES,

205
00:07:03,713 --> 00:07:05,348
WHICH CAN INCLUDE HYPERTENSIVE

206
00:07:05,348 --> 00:07:09,052
DISORDERS OF PREGNANCY OR HDP,

207
00:07:09,052 --> 00:07:10,920
GESTATIONAL DIABETES OR GDM,

208
00:07:10,920 --> 00:07:13,390
PRETERM BIRTH OR PTB HERE OR

209
00:07:13,390 --> 00:07:14,624
SMALL FOR GESTATIONAL AGE IS

210
00:07:14,624 --> 00:07:16,726
WHEN WE SEE THE SIGNAL MOVING ON

211
00:07:16,726 --> 00:07:18,395
TO CLINICAL CARDIOVASCULAR

212
00:07:18,395 --> 00:07:21,331
DISEASE.

213
00:07:21,331 --> 00:07:22,866
ONE OF THE LARGEST AND BEST

214
00:07:22,866 --> 00:07:24,033
STUDIES IN THE LAST SEVERAL

215
00:07:24,033 --> 00:07:25,568
YEARS THAT HAS LOOKED AT THE

216
00:07:25,568 --> 00:07:27,537
ASSOCIATION OF ADVERSE PREGNANCY

217
00:07:27,537 --> 00:07:30,073
OUTCOMES AND LIFETIME RISK OF

218
00:07:30,073 --> 00:07:30,940
CARDIOVASCULAR DISEASE IS SHOWN

219
00:07:30,940 --> 00:07:31,908
HERE.

220
00:07:31,908 --> 00:07:34,544
THIS STUDY THAT INCLUDED OVER

221
00:07:34,544 --> 00:07:35,645
2 MILLION SWEDISH INDIVIDUALS

222
00:07:35,645 --> 00:07:39,382
WHO HAD HAD PREGNANCIES BETWEEN

223
00:07:39,382 --> 00:07:42,652
1970 TO 2000 WERE FOLLOWED FOR A

224
00:07:42,652 --> 00:07:44,487
MEDIAN OF AT LEAST 25 YEARS WITH

225
00:07:44,487 --> 00:07:49,192
A MAXIMUM OF 46 YEARS AT AGE 27

226
00:07:49,192 --> 00:07:50,760
AT FIRST DELIVERY, WERE THEN

227
00:07:50,760 --> 00:07:53,129
EVALUATED FOR THEIR RISK OF

228
00:07:53,129 --> 00:07:53,630
ISCHEMIC HEART DISEASE.

229
00:07:53,630 --> 00:07:54,898
AS YOU CAN SEE IN THIS FIGURE,

230
00:07:54,898 --> 00:07:58,168
THE RISK ASSOCIATED WITH EACH

231
00:07:58,168 --> 00:08:01,371
APO IS INCREASED FOR THE RISK OF

232
00:08:01,371 --> 00:08:02,005
CVD.

233
00:08:02,005 --> 00:08:03,773
NOW WE SEE DIFFERENT PATTERNS

234
00:08:03,773 --> 00:08:04,741
ACROSS ADVERSE PREGNANCY

235
00:08:04,741 --> 00:08:05,608
OUTCOMES WITH SOME OF THE

236
00:08:05,608 --> 00:08:07,410
HIGHEST RISK RELATED TO

237
00:08:07,410 --> 00:08:08,378
PREECLAMPSIA, BUT CONSISTENT

238
00:08:08,378 --> 00:08:12,182
PATTERNS THROUGHOUT.

239
00:08:12,182 --> 00:08:13,850
ONE OF THE THINGS THAT WAS

240
00:08:13,850 --> 00:08:15,652
REALLY INTERESTING ABOUT THIS

241
00:08:15,652 --> 00:08:17,086
ANALYSIS WAS THAT THEY ALSO

242
00:08:17,086 --> 00:08:18,054
LOOKED AT THE INDIVIDUALS WHO

243
00:08:18,054 --> 00:08:19,923
HAD MULTIPLE ADVERSE PREGNANCY

244
00:08:19,923 --> 00:08:21,691
OUTCOMES AND DEMONSTRATED THIS

245
00:08:21,691 --> 00:08:24,327
ADDITIVE EFFECT, SO IF YOU HAD

246
00:08:24,327 --> 00:08:26,095
PRETERM AND PREECLAMPSIA OR

247
00:08:26,095 --> 00:08:27,397
PRETERM AND GESTATIONAL

248
00:08:27,397 --> 00:08:29,032
DIABETES, YOU HAD AN EVEN HIGHER

249
00:08:29,032 --> 00:08:31,668
RISK OF ISCHEMIC HEART DISEASE

250
00:08:31,668 --> 00:08:33,169
IN FOLLOW-UP AND WHAT'S EVEN

251
00:08:33,169 --> 00:08:34,304
MORE IMPORTANT IS THAT ABOUT A

252
00:08:34,304 --> 00:08:36,773
THIRD OF PEOPLE HAD AT LEAST ONE

253
00:08:36,773 --> 00:08:37,774
ADVERSE PREGNANCY OUT COME, SO

254
00:08:37,774 --> 00:08:39,209
THIS IS A PREVALENT COMPLICATION

255
00:08:39,209 --> 00:08:41,711
THAT IS ASSOCIATED WITH UP TO A

256
00:08:41,711 --> 00:08:43,480
TWOFOLD RISK OF CARDIOVASCULAR

257
00:08:43,480 --> 00:08:47,717
DISEASE ACROSS THE LIFE COURSE.

258
00:08:47,717 --> 00:08:50,253
SO IF WE WANT TO THINK ABOUT

259
00:08:50,253 --> 00:08:51,955
THAT STRUCTURE OF ADVERSE

260
00:08:51,955 --> 00:08:53,223
PREGNANCY OUT COME GOING TO

261
00:08:53,223 --> 00:08:54,691
CARDIOVASCULAR DISEASE, I THINK

262
00:08:54,691 --> 00:08:56,025
IT'S HELPFUL TO THINK ABOUT THE

263
00:08:56,025 --> 00:08:57,126
PATHWAYS THROUGH WHICH THIS MAY

264
00:08:57,126 --> 00:08:58,428
OCCUR, WHERE WE HAVE DATA AND

265
00:08:58,428 --> 00:09:00,296
WHERE WE MAY NEED MORE DATA TO

266
00:09:00,296 --> 00:09:02,365
UNDERSTAND WHERE WE COULD MODIFY

267
00:09:02,365 --> 00:09:03,900
AND TARGET TO REALLY OPTIMIZE

268
00:09:03,900 --> 00:09:06,302
PREVENTION.

269
00:09:06,302 --> 00:09:08,271
SO LET'S FIRST START WITH

270
00:09:08,271 --> 00:09:09,172
TRADITIONAL CARDIOVASCULAR

271
00:09:09,172 --> 00:09:13,209
DISEASE RISK FACTORS.

272
00:09:13,209 --> 00:09:15,178
DATA FROM THE NURSES HEALTH

273
00:09:15,178 --> 00:09:16,713
2 STUDY ARE AMONG SOME OF THE

274
00:09:16,713 --> 00:09:19,449
LARGEST SAMPLE WHERE WE HAVE

275
00:09:19,449 --> 00:09:20,550
INDIVIDUALS WHO ARE FOLLOWED

276
00:09:20,550 --> 00:09:23,653
FROM THEIR FIRST BIRTH TO

277
00:09:23,653 --> 00:09:25,788
INCIDENCE OF CARDIOVASCULAR

278
00:09:25,788 --> 00:09:28,057
DISEASE OVER A FOLLOW-UP OF MORE

279
00:09:28,057 --> 00:09:28,658
THAN 40 YEARS.

280
00:09:28,658 --> 00:09:30,927
SHOWN IN THIS TABLE IS THE

281
00:09:30,927 --> 00:09:32,328
PROPORTION MEDIATED FOR

282
00:09:32,328 --> 00:09:35,198
TRADITIONAL RISK FACTORS AFTER

283
00:09:35,198 --> 00:09:36,499
AN INCIDENT HYPERTENSIVE

284
00:09:36,499 --> 00:09:38,034
DISORDER OF PREGNANCY,

285
00:09:38,034 --> 00:09:40,670
SPECIFICALLY HYPERTENSION,

286
00:09:40,670 --> 00:09:41,638
HYPERLIPIDEMIA, DIABETES, AND

287
00:09:41,638 --> 00:09:47,377
CHANGE IN BMI.

288
00:09:47,377 --> 00:09:49,579
WHAT'S REALLY STRIKING IS 84% OF

289
00:09:49,579 --> 00:09:50,713
THE ASSOCIATION BETWEEN

290
00:09:50,713 --> 00:09:51,981
GESTATIONAL HYPERTENSION AND 57%

291
00:09:51,981 --> 00:09:53,449
OF THE ASSOCIATION BETWEEN

292
00:09:53,449 --> 00:09:55,652
PREECLAMPSIA AND FOLLOW-UP CVD

293
00:09:55,652 --> 00:09:58,288
IS MEDIATED BY THESE TRADITIONAL

294
00:09:58,288 --> 00:10:00,456
RISK FACTORS, SO TARGETS THAT WE

295
00:10:00,456 --> 00:10:02,125
COMMONLY THINK ABOUT AFTER

296
00:10:02,125 --> 00:10:03,860
HYPERTENSIVE DISORDERS OF

297
00:10:03,860 --> 00:10:05,161
PREGNANCY MEDIATE THE MAJORITY

298
00:10:05,161 --> 00:10:07,730
OF THE RISK FOR CARDIOVASCULAR

299
00:10:07,730 --> 00:10:09,332
DISEASE AND HIGHLIGHT KEY

300
00:10:09,332 --> 00:10:11,167
TARGETS ONCE SOMEONE HAS BEEN

301
00:10:11,167 --> 00:10:12,569
IDENTIFIED WITH ELEVATED BLOOD

302
00:10:12,569 --> 00:10:14,771
PRESSURE DURING PREGNANCY.

303
00:10:14,771 --> 00:10:15,538
NOW WHAT'S IMPORTANT IS THAT

304
00:10:15,538 --> 00:10:18,074
THESE ARE IMPORTANT FACTORS OR

305
00:10:18,074 --> 00:10:19,108
TARGETS WHETHER OR NOT SOMEONE

306
00:10:19,108 --> 00:10:21,244
GOES ON TO HAVE CHRONIC

307
00:10:21,244 --> 00:10:22,645
HYPERTENSION, TO JUST HAVING

308
00:10:22,645 --> 00:10:23,513
ELEVATED BLOOD PRESSURE IN

309
00:10:23,513 --> 00:10:25,682
PREGNANCY ITSELF THAT IS

310
00:10:25,682 --> 00:10:27,150
ASSOCIATED WITH FUTURE

311
00:10:27,150 --> 00:10:28,451
CARDIOVASCULAR DISEASE RISK WHEN

312
00:10:28,451 --> 00:10:30,887
DEFINED AS HYPERTENSIVE DISORDER

313
00:10:30,887 --> 00:10:35,325
OF PREGNANCY.

314
00:10:35,325 --> 00:10:36,659
THE NEXT PATHWAY THAT WE'LL TALK

315
00:10:36,659 --> 00:10:38,428
ABOUT IS ABNORMAL CARDIAC

316
00:10:38,428 --> 00:10:38,995
MECHANICS.

317
00:10:38,995 --> 00:10:41,664
WE ALSO KNOW THAT WHEN WE THINK

318
00:10:41,664 --> 00:10:44,400
ABOUT CARDIOVASCULAR DISEASE

319
00:10:44,400 --> 00:10:46,603
BROADLY, HEART FAILURE CAN BE A

320
00:10:46,603 --> 00:10:47,270
COMPLICATION FOLLOWING ADVERSE

321
00:10:47,270 --> 00:10:47,804
PREGNANCY OUTCOMES.

322
00:10:47,804 --> 00:10:49,238
WHILE WE HAVE LESS DATA HERE,

323
00:10:49,238 --> 00:10:51,074
THIS IS A REALLY INTERESTING

324
00:10:51,074 --> 00:10:52,842
SINGLE CENTER STUDY THAT LOOKED

325
00:10:52,842 --> 00:10:56,312
AT ABOUT 130 WOMEN WHO WERE 8 TO

326
00:10:56,312 --> 00:10:58,314
10 YEARS AFTER DELIVERY, WHO HAD

327
00:10:58,314 --> 00:10:59,616
EXPERIENCED A HYPERTENSIVE

328
00:10:59,616 --> 00:11:02,685
DISORDER OF PREGNANCY, AND

329
00:11:02,685 --> 00:11:03,886
EXAMINED ECHO CARDIOGRAPHIC

330
00:11:03,886 --> 00:11:05,855
EVIDENCE OF SEPTAL WALL

331
00:11:05,855 --> 00:11:07,590
THICKNESS, LV WALL REMODELING

332
00:11:07,590 --> 00:11:09,158
AND MITRAL INFLOW TO LOOK AT

333
00:11:09,158 --> 00:11:10,893
PATTERNS OF ADVERSE CARDIAC

334
00:11:10,893 --> 00:11:11,327
REMODELING.

335
00:11:11,327 --> 00:11:14,297
NOW IMPORTANTLY, OF THEIR

336
00:11:14,297 --> 00:11:15,865
SAMPLE, 23% HAD HYPERTENSIVE

337
00:11:15,865 --> 00:11:18,768
DISORDERS OF PREGNANCY AND A

338
00:11:18,768 --> 00:11:20,837
MUCH GREATER PROPORTION OF

339
00:11:20,837 --> 00:11:23,906
INDIVIDUALS, 63% VERSUS 26%, HAD

340
00:11:23,906 --> 00:11:25,108
HYPERTENSION POST-DELIVERY WHO

341
00:11:25,108 --> 00:11:26,876
HAD HAD HYPERTENSIVE DISORDERS.

342
00:11:26,876 --> 00:11:28,378
SO THERE WAS AN ADDITIVE EFFECT

343
00:11:28,378 --> 00:11:30,146
WHERE PEOPLE WHO HAD HAD

344
00:11:30,146 --> 00:11:31,447
HYPERTENSIVE DISORDERS OF

345
00:11:31,447 --> 00:11:33,416
PREGNANCY AND HYPERTENSION HAD

346
00:11:33,416 --> 00:11:37,053
THE MOST ADVERSE REMODELING IN

347
00:11:37,053 --> 00:11:40,323
THEIR LEFT VENTRICLE.

348
00:11:40,323 --> 00:11:41,524
ONE OF THE THINGS THAT THIS

349
00:11:41,524 --> 00:11:43,159
STUDY RELY HIGHLIGHTED IS THAT

350
00:11:43,159 --> 00:11:44,927
THESE ADVERSE CHANGES THAT WERE

351
00:11:44,927 --> 00:11:46,763
OBSERVED 8 TO 10 YEARS AFTER

352
00:11:46,763 --> 00:11:49,599
PREGNANCY MAY HAVE BEEN

353
00:11:49,599 --> 00:11:51,034
MANIFESTATIONS OF

354
00:11:51,034 --> 00:11:52,068
PATHOPHYSIOLOGIC RESPONSES

355
00:11:52,068 --> 00:11:53,970
RELATED TO PREGNANCY ITSELF,

356
00:11:53,970 --> 00:11:56,806
ESPECIALLY AMONG THOSE WHO HAD

357
00:11:56,806 --> 00:11:57,507
HYPERTENSIVE DISORDERS.

358
00:11:57,507 --> 00:11:59,642
THIS DIAGRAM HIGHLIGHTS THE

359
00:11:59,642 --> 00:12:01,444
IMPORTANCE OF THE LEFT

360
00:12:01,444 --> 00:12:02,645
VENTRICLE'S ADAPTATION TO

361
00:12:02,645 --> 00:12:04,480
PREGNANCY THAT MAY ACTUALLY BE

362
00:12:04,480 --> 00:12:06,582
INFLUENCED BY PRE-EXISTING

363
00:12:06,582 --> 00:12:07,216
CARDIOVASCULAR DISEASE ORIS

364
00:12:07,216 --> 00:12:07,784
BEING.

365
00:12:07,784 --> 00:12:09,419
AND WE'LL TALK A LITTLE BIT MORE

366
00:12:09,419 --> 00:12:11,020
ABOUT THIS IN THE FOLLOWING

367
00:12:11,020 --> 00:12:13,022
SLIDES, BUT THE IDEA THAT

368
00:12:13,022 --> 00:12:14,891
POTENTIALLY SOME OF THE ADVERSE

369
00:12:14,891 --> 00:12:16,726
LV REMODELING MAY HAVE ALREADY

370
00:12:16,726 --> 00:12:18,361
BEEN PRESENT BEFORE THE

371
00:12:18,361 --> 00:12:19,462
PREGNANCY IS A QUESTION THAT

372
00:12:19,462 --> 00:12:24,567
REMAINS UNANSWERED.

373
00:12:24,567 --> 00:12:25,501
SO LET'S TALK ABOUT THE

374
00:12:25,501 --> 00:12:29,872
MECHANISM AND PATHWAY TO@THROW

375
00:12:29,872 --> 00:12:30,940
SCLEROSIS OR HEART DISEASE THAT

376
00:12:30,940 --> 00:12:33,476
IS SUBCLINICAL@THROW SCLEROSIS.

377
00:12:33,476 --> 00:12:34,911
ONE OF THE LARGEST STUDIES THAT

378
00:12:34,911 --> 00:12:36,345
WAS RECENTLY PUBLISHED COMES

379
00:12:36,345 --> 00:12:39,148
FROM THE SWEDISH CARDIOPULMONARY

380
00:12:39,148 --> 00:12:39,615
BIOIMAGE STUDY.

381
00:12:39,615 --> 00:12:41,584
THIS STUDY HAD ABOUT 10,000

382
00:12:41,584 --> 00:12:44,554
INDIVIDUALS WHO WERE 50 TO 65

383
00:12:44,554 --> 00:12:47,156
YEARS WHO HAD HAD A PRIOR BIRTH

384
00:12:47,156 --> 00:12:49,559
WITHIN THE SWEDISH SYSTEM.

385
00:12:49,559 --> 00:12:51,861
ABOUT 19% HAD AN ADVERSE

386
00:12:51,861 --> 00:12:55,565
PREGNANCY OUT COME AND THEN WERE

387
00:12:55,565 --> 00:12:59,402
EXAMINED WITH A CORONARY CTA.

388
00:12:59,402 --> 00:13:00,937
THE INNOVATIVE PIECE ABOUT THIS

389
00:13:00,937 --> 00:13:02,572
STUDY IS THAT THEY LOOKED NOT

390
00:13:02,572 --> 00:13:06,075
JUST AT CORONARY CALCIUM, BUT

391
00:13:06,075 --> 00:13:08,611
ALSO AT NON-CALCIFIED PLAQUE

392
00:13:08,611 --> 00:13:10,646
WITH CTA.

393
00:13:10,646 --> 00:13:12,815
PARTICULARLY AMONG YOUNG WOMEN,

394
00:13:12,815 --> 00:13:14,584
BEFORE ANY CALCIFIED PLAQUE IS

395
00:13:14,584 --> 00:13:19,622
PRESENT, ANY CORONARY

396
00:13:19,622 --> 00:13:20,523
ATHEROSCLEROSIS WAS PRESENT AND

397
00:13:20,523 --> 00:13:21,624
THAT'S SPECIFICALLY WHAT THEY

398
00:13:21,624 --> 00:13:22,358
SAW.

399
00:13:22,358 --> 00:13:23,159
SPECIFICALLY AMONG INDIVIDUALS

400
00:13:23,159 --> 00:13:24,994
WHO HAD ADVERSE PREGNANCY OUT

401
00:13:24,994 --> 00:13:31,234
COME, 32% HAD ANY.

402
00:13:31,234 --> 00:13:33,102
IF WE LOOK ACROSS THE VARIOUS

403
00:13:33,102 --> 00:13:37,240
OUTCOMES THAT WERE OBSERVED, ANY

404
00:13:37,240 --> 00:13:39,142
STENOSIS, ANY CALCIFIED PLAQUE

405
00:13:39,142 --> 00:13:40,510
OR SCORE GREATER THAN 100, WE

406
00:13:40,510 --> 00:13:42,278
SEE A CONSISTENT PATTERN OF

407
00:13:42,278 --> 00:13:45,114
HIGHER BURDEN OF

408
00:13:45,114 --> 00:13:46,315
CORONARY@SCLEROSIS OR

409
00:13:46,315 --> 00:13:47,517
SUBCLINICAL AMONG THOSE WHO

410
00:13:47,517 --> 00:13:48,818
EXPERIENCE AN ADVERSE PREGNANCY

411
00:13:48,818 --> 00:13:51,988
OUT COME.

412
00:13:51,988 --> 00:13:53,089
SO IF WE THOUGHT ABOUT THE

413
00:13:53,089 --> 00:13:55,625
DIFFERENT PATHWAYS FROM

414
00:13:55,625 --> 00:13:57,794
SUBCLINICAL CVD TO CLINICAL CVD,

415
00:13:57,794 --> 00:14:00,263
WE HAVE TO ALSO ASK ABOUT WHAT

416
00:14:00,263 --> 00:14:02,298
ARE THE ANTECEDENTS TO BOTH

417
00:14:02,298 --> 00:14:04,467
ADVERSE PREGNANCY OUTCOMES AND

418
00:14:04,467 --> 00:14:06,669
CVD THAT MAY HELP US IDENTIFY

419
00:14:06,669 --> 00:14:09,939
EARLIER PREVENTION STRATEGIES.

420
00:14:09,939 --> 00:14:11,841
IF WE THINK ABOUT THE SHARED

421
00:14:11,841 --> 00:14:13,342
ANTECEDENT PATHWAYS, THERE ARE

422
00:14:13,342 --> 00:14:15,511
TRADITIONAL RISK FACTORS LIKE

423
00:14:15,511 --> 00:14:17,046
OBESITY, SEDENTARY BEHAVIOR,

424
00:14:17,046 --> 00:14:19,816
POOR QUALITY DIET, PRE-EXISTING

425
00:14:19,816 --> 00:14:21,317
HYPERTENSION, HYPERLIPIDEMIA OR

426
00:14:21,317 --> 00:14:23,619
DIABETES, AS WELL AS PREGNANCY

427
00:14:23,619 --> 00:14:25,154
OR RELATED RISK FACTORS UNIQUE

428
00:14:25,154 --> 00:14:27,456
OH A BIRTHING INDIVIDUAL THAT

429
00:14:27,456 --> 00:14:29,192
MAY INCLUDE VASCULAR AND

430
00:14:29,192 --> 00:14:31,160
PLACENTAL DYSFUNCTION OR GENETIC

431
00:14:31,160 --> 00:14:31,928
PREDISPOSITION TO ADVERSE

432
00:14:31,928 --> 00:14:34,597
PREGNANCY OUTCOMES THAT LEAD TO

433
00:14:34,597 --> 00:14:37,967
THIS PATH OF CVD.

434
00:14:37,967 --> 00:14:38,601
BUT ONE OF THE KEY QUESTIONS

435
00:14:38,601 --> 00:14:40,303
THAT REMAINS UNANSWERED IS

436
00:14:40,303 --> 00:14:41,871
WHETHER OR NOT THE ADVERSE

437
00:14:41,871 --> 00:14:43,306
PREGNANCY OUT COME ITSELF IS A

438
00:14:43,306 --> 00:14:48,244
MARKER OR MEDIATOR OF FUTURE

439
00:14:48,244 --> 00:14:49,212
CARDIOVASCULAR DISEASE RISK.

440
00:14:49,212 --> 00:14:50,313
THIS SCHEMATIC ORIGINALLY

441
00:14:50,313 --> 00:14:52,281
PUBLISHED OVER 20 YEARS

442
00:14:52,281 --> 00:14:53,149
HIGHLIGHTS TWO DIFFERENT

443
00:14:53,149 --> 00:14:54,150
TRAJECTORIES IN A BIRTHING

444
00:14:54,150 --> 00:14:54,584
INDIVIDUAL.

445
00:14:54,584 --> 00:14:56,953
ONE BY WHICH THE INDIVIDUAL HAS

446
00:14:56,953 --> 00:15:01,123
TWO PREGNANCIES WITH AN ADVERSE

447
00:15:01,123 --> 00:15:02,658
PREGNANCY OUTCOME, AND ONE BY

448
00:15:02,658 --> 00:15:03,960
WHICH AN INDIVIDUAL HAS A

449
00:15:03,960 --> 00:15:04,727
HEALTHY PREGNANCY.

450
00:15:04,727 --> 00:15:07,263
YOU CAN SEE THE QUESTION HERE IS

451
00:15:07,263 --> 00:15:09,565
THAT WHETHER OR NOT THESE TWO

452
00:15:09,565 --> 00:15:10,366
INDIVIDUALS MEET THE THRESHOLD

453
00:15:10,366 --> 00:15:12,168
FOR DEVELOPING VASCULAR RISK,

454
00:15:12,168 --> 00:15:13,636
WHETHER THAT'S CARDIOVASCULAR

455
00:15:13,636 --> 00:15:16,005
DISEASE OR HYPERTENSION, REALLY

456
00:15:16,005 --> 00:15:17,907
DEPENDS ON THEIR STARTING POINT

457
00:15:17,907 --> 00:15:19,976
AS WELL AS THE INJURY RELATED TO

458
00:15:19,976 --> 00:15:21,577
PREGNANCY.

459
00:15:21,577 --> 00:15:23,679
SO THE FUNDAMENTAL QUESTION

460
00:15:23,679 --> 00:15:24,881
REMAINS, IS AN INDIVIDUAL WHO

461
00:15:24,881 --> 00:15:26,649
HAS AN ADVERSE PREGNANCY OUT

462
00:15:26,649 --> 00:15:30,019
COME REALLY UNMASKED IN THIS

463
00:15:30,019 --> 00:15:31,220
LATENT RISK THAT ALREADY EXISTED

464
00:15:31,220 --> 00:15:33,089
AND THEY CONTINUE ON THEIR

465
00:15:33,089 --> 00:15:34,290
TRAJECTORY THEY WERE ALREADY ON

466
00:15:34,290 --> 00:15:35,925
OR IS THERE SOMETHING ABOUT THE

467
00:15:35,925 --> 00:15:37,126
ADVERSE PREGNANCY OUT COME THAT

468
00:15:37,126 --> 00:15:38,527
ALTERS THEIR TRAJECTORY AND

469
00:15:38,527 --> 00:15:40,296
LEADS THEM INTO A HIGHER RISK

470
00:15:40,296 --> 00:15:43,266
CATEGORY?

471
00:15:43,266 --> 00:15:45,668
SO SHOWN HERE IN A CAUSAL

472
00:15:45,668 --> 00:15:47,069
STRUCTURE DIAGRAM, WE REALLY

473
00:15:47,069 --> 00:15:50,439
WANTED TO ASK THIS QUESTION OF

474
00:15:50,439 --> 00:15:51,674
IF ADVERSE PREGNANCY OUTCOMES

475
00:15:51,674 --> 00:15:54,176
ARE A MARKER OR MEDIATOR BASED

476
00:15:54,176 --> 00:15:56,946
ON WHERE SOMEONE BEGINS THEIR

477
00:15:56,946 --> 00:15:57,914
PREPREGNANCY CARDIOMETABOLIC

478
00:15:57,914 --> 00:15:59,415
HEALTH, WHAT THEIR

479
00:15:59,415 --> 00:16:00,316
CARDIOMETABOLIC HEALTH MAY BE

480
00:16:00,316 --> 00:16:01,384
AFTER PREGNANCY, AND WHAT THAT

481
00:16:01,384 --> 00:16:03,719
MEANS FOR THEIR RISK FOR

482
00:16:03,719 --> 00:16:04,353
CARDIOVASCULAR DISEASE, GIVEN

483
00:16:04,353 --> 00:16:06,522
THAT EACH OF THESE INDEPENDENT

484
00:16:06,522 --> 00:16:08,190
PATHWAYS MAY BE LEADING TO

485
00:16:08,190 --> 00:16:09,258
HIGHER CARDIOVASCULAR DISEASE

486
00:16:09,258 --> 00:16:11,260
RISK.

487
00:16:11,260 --> 00:16:12,395
SAID ANOTHER WAY, THIS ANALOGY

488
00:16:12,395 --> 00:16:14,330
OF THIS PICTURE SHOWN HERE ARE

489
00:16:14,330 --> 00:16:15,631
ADVERSE PREGNANCY OUTCOMES

490
00:16:15,631 --> 00:16:17,633
REALLY THE SMOKE DETECTOR

491
00:16:17,633 --> 00:16:18,935
HIGHLIGHTING THE RISK THAT

492
00:16:18,935 --> 00:16:20,336
ALREADY EXISTS WHEN THERE'S A

493
00:16:20,336 --> 00:16:23,940
FIRE IN THE HOUSE.

494
00:16:23,940 --> 00:16:24,941
SO HOW CAN WE START TO

495
00:16:24,941 --> 00:16:25,942
UNDERSTAND THIS?

496
00:16:25,942 --> 00:16:28,444
IN WORK FUNDED BY THE NHLBI IN

497
00:16:28,444 --> 00:16:30,513
THE NEW MOM TO BE HEART HEALTH

498
00:16:30,513 --> 00:16:34,283
STUDY, WHICH IS A COHORT OF

499
00:16:34,283 --> 00:16:35,217
INDIVIDUALS RECRUITED IN THE

500
00:16:35,217 --> 00:16:37,186
BEGINNING OF THEIR FIRST

501
00:16:37,186 --> 00:16:39,155
PREGNANCY, SO WE HAD EARLY

502
00:16:39,155 --> 00:16:41,290
MEASURES OF BMI EARLY IN THE

503
00:16:41,290 --> 00:16:44,327
FIRST TRIMESTER, AND WERE THEN

504
00:16:44,327 --> 00:16:45,628
FOLLOWED DURING THIS PREGNANCY

505
00:16:45,628 --> 00:16:47,797
AND NOW HAVE BEEN FOLLOWED FOR

506
00:16:47,797 --> 00:16:50,333
ABOUT 10 YEARS POSTPARTUM.

507
00:16:50,333 --> 00:16:52,802
AT 2 TO 7 YEARS DURING FOLLOW-UP

508
00:16:52,802 --> 00:16:54,603
POSTPARTUM RISK FACTORS WERE

509
00:16:54,603 --> 00:16:56,339
MEASURED AND ALLOWED US TO

510
00:16:56,339 --> 00:16:59,075
STRUCTURE OUR QUESTION OF

511
00:16:59,075 --> 00:17:01,243
INTEREST WITH THIS SHOWN HERE,

512
00:17:01,243 --> 00:17:03,346
PREPREGNANCY OR EARLY PREGNANCY

513
00:17:03,346 --> 00:17:04,647
BMI ASSOCIATE WITH ADVERSE

514
00:17:04,647 --> 00:17:06,849
PREGNANCY OUTCOMES AS WELL AS

515
00:17:06,849 --> 00:17:07,616
POSTPARTUM CARDIOVASCULAR

516
00:17:07,616 --> 00:17:08,951
DISEASE RISK FACTORS, AND WHAT

517
00:17:08,951 --> 00:17:11,187
PROPORTION OF THAT IS MEDIATED

518
00:17:11,187 --> 00:17:14,056
IF ANY BY ADVERSE PREGNANCY

519
00:17:14,056 --> 00:17:15,825
OUTCOMES?

520
00:17:15,825 --> 00:17:18,327
SO IF WE'LL BREAK DOWN THE

521
00:17:18,327 --> 00:17:19,328
EFFECT OR ASSOCIATIONS WE'LL

522
00:17:19,328 --> 00:17:20,997
LOOK AT THE TOTAL EFFECTIVENESS

523
00:17:20,997 --> 00:17:22,264
ANALYSIS LOOKING AT THE

524
00:17:22,264 --> 00:17:25,668
PREPREGNANCY BMI AND POSTPARTUM

525
00:17:25,668 --> 00:17:26,969
CVD RIS FACTORS.

526
00:17:26,969 --> 00:17:28,204
WE BROKE THAT DOWN INTO THE

527
00:17:28,204 --> 00:17:29,705
DIRECT AND INDIRECT EFFECT TO

528
00:17:29,705 --> 00:17:37,113
GET AT THE PROPORTION MEDIATED.

529
00:17:37,113 --> 00:17:40,716
IF WE LOOK HERE AT THE TOTAL

530
00:17:40,716 --> 00:17:43,119
EFFECT, THE UNADJUSTED AND

531
00:17:43,119 --> 00:17:47,156
ADJUSTED BETA COEFFICIENT

532
00:17:47,156 --> 00:17:49,558
SHOW -- AND HYPERTENSION AND

533
00:17:49,558 --> 00:17:51,327
HYPERLIPIDEMIA IN THE FOLLOW-UP

534
00:17:51,327 --> 00:17:53,963
POSTPARTUM PERIOD.

535
00:17:53,963 --> 00:17:55,131
HOWEVER, WHEN WE ACCOUNT FOR THE

536
00:17:55,131 --> 00:17:56,932
RISK FACTORS COMING IN TO

537
00:17:56,932 --> 00:17:58,667
PREGNANCY, AND WE EXAMINE THE

538
00:17:58,667 --> 00:18:00,870
PROPORTION MEDIATED, ONLY A

539
00:18:00,870 --> 00:18:03,039
SMALL PROPORTION, LESS THAN 20%

540
00:18:03,039 --> 00:18:05,141
OF THAT, IS MEDIATED BY THE

541
00:18:05,141 --> 00:18:06,542
HYPERTENSIVE DISORDER OF

542
00:18:06,542 --> 00:18:08,110
PREGNANCY FOR HYPERTENSION AND

543
00:18:08,110 --> 00:18:10,146
THERE'S NO MEDIATION WITH

544
00:18:10,146 --> 00:18:11,580
HYPERLIPIDEMIA.

545
00:18:11,580 --> 00:18:13,416
THIS HIGHLIGHTS THE IMPORTANCE

546
00:18:13,416 --> 00:18:14,984
OF ADVERSE PREGNANCY OUTCOMES AS

547
00:18:14,984 --> 00:18:17,920
A MARKER AND NOT A MEDIATOR OF

548
00:18:17,920 --> 00:18:19,789
THE ASSOCIATION WITH

549
00:18:19,789 --> 00:18:20,623
CARDIOVASCULAR DISEASE RISK.

550
00:18:20,623 --> 00:18:22,925
NOW THESE WERE EARLY OUTCOMES IN

551
00:18:22,925 --> 00:18:24,160
THE SHORT TERM AND FUTURE

552
00:18:24,160 --> 00:18:25,461
FOLLOW-UP STUDIES ARE STILL

553
00:18:25,461 --> 00:18:26,996
NEEDED INCLUDING IN THIS COHORT

554
00:18:26,996 --> 00:18:33,135
AND OTHERS.

555
00:18:33,135 --> 00:18:34,336
SO LET'S MOVE ON TO THE NEXT

556
00:18:34,336 --> 00:18:35,404
QUESTION, WHAT IS THE

557
00:18:35,404 --> 00:18:36,272
EPIDEMIOLOGY OF ADVERSE

558
00:18:36,272 --> 00:18:38,574
PREGNANCY OUTCOMES AND POTENTIAL

559
00:18:38,574 --> 00:18:39,575
DRIVERS, WHAT DOES THE BURDEN

560
00:18:39,575 --> 00:18:40,576
LOOK LIKE IN THE U.S.

561
00:18:40,576 --> 00:18:42,411
POPULATION?

562
00:18:42,411 --> 00:18:45,047
SO IF WE ZERO IN ON THE

563
00:18:45,047 --> 00:18:46,449
SHORT-TERM PERIOD HERE IN THE

564
00:18:46,449 --> 00:18:48,317
MIDDLE OF THIS CONCEPTUAL FIGURE

565
00:18:48,317 --> 00:18:51,587
WE'VE BEEN USING, AS MANY OF YOU

566
00:18:51,587 --> 00:18:53,789
ARE AWARE, CARDIOVASCULAR

567
00:18:53,789 --> 00:18:56,525
DISEASE IS A LEADING CAUSE OF

568
00:18:56,525 --> 00:18:58,594
MATERNAL DEATHS AND THE MATERNAL

569
00:18:58,594 --> 00:19:02,665
MORTALITY RATIO IN THE IN 2018

570
00:19:02,665 --> 00:19:04,533
IMAIRED OTHER HIGH-INCOME

571
00:19:04,533 --> 00:19:05,601
COUNTRIES WHICH HAS

572
00:19:05,601 --> 00:19:07,403
UNFORTUNATELY ONLY INCREASED

573
00:19:07,403 --> 00:19:09,672
SINCE THEN IS MUCH HIGHER THAN

574
00:19:09,672 --> 00:19:10,439
OTHER HIGH-INCOME COUNTRIES.

575
00:19:10,439 --> 00:19:11,740
FURTHER, GREATER THAN 80% OF

576
00:19:11,740 --> 00:19:13,509
THESE DEATHS ARE PREVENTIBLE,

577
00:19:13,509 --> 00:19:14,743
WHICH WITH CARDIOVASCULAR

578
00:19:14,743 --> 00:19:19,849
DISEASE BEING A LEADING CAUSE.

579
00:19:19,849 --> 00:19:22,151
ONE OF THE THINGS THAT IS REALLY

580
00:19:22,151 --> 00:19:25,988
STRIKING IS THAT A LOT OF THESE

581
00:19:25,988 --> 00:19:27,056
PREGNANCY-RELATED DEATHS OCCUR

582
00:19:27,056 --> 00:19:29,091
IN THE POSTPARTUM PERIOD, SO

583
00:19:29,091 --> 00:19:31,360
MORE THAN TWO THIRDS OF DEATHS

584
00:19:31,360 --> 00:19:34,396
ARE OCCURRING IN THE PERIOD

585
00:19:34,396 --> 00:19:37,466
AFTER PREGNANCY, PARTICULARLY IN

586
00:19:37,466 --> 00:19:39,768
THAT 43 TO 365 DAY POSTPARTUM

587
00:19:39,768 --> 00:19:41,871
PERIOD WHEN MANY PEOPLE MAY NOT

588
00:19:41,871 --> 00:19:43,506
EVEN CONSIDER THEMSELVES

589
00:19:43,506 --> 00:19:44,907
POSTPARTUM ANYMORE, BUT

590
00:19:44,907 --> 00:19:46,442
PARTICULARLY THOSE

591
00:19:46,442 --> 00:19:47,309
CARDIOVASCULAR CONTRIBUTIONS

592
00:19:47,309 --> 00:19:50,479
RELATED TO HYPERTENSION, STROKE,

593
00:19:50,479 --> 00:19:51,914
CARDIOMYOPATHY, MAY STILL BE A

594
00:19:51,914 --> 00:19:56,919
PROMINENT CAUSE OF THESE DEATHS.

595
00:19:56,919 --> 00:19:58,354
IF WE LOOK AT THIS IN A

596
00:19:58,354 --> 00:19:59,755
DIFFERENT WAY, THE ABSOLUTE

597
00:19:59,755 --> 00:20:02,024
BURDEN, WHAT ARE THE COUNTS IN

598
00:20:02,024 --> 00:20:03,993
2019 IN THE PRECOVID ERA TO GET

599
00:20:03,993 --> 00:20:05,027
A SENSE OF THIS?

600
00:20:05,027 --> 00:20:07,596
WELL, THERE'S NEARLY 300,000

601
00:20:07,596 --> 00:20:09,198
LIVE BIRTHS THAT ARE COMPLICATED

602
00:20:09,198 --> 00:20:11,367
BY HYPERTENSIVE DISORDERS, ABOUT

603
00:20:11,367 --> 00:20:13,936
50,000 WITH MATERNAL MORBIDITY,

604
00:20:13,936 --> 00:20:16,405
10,000 WITH ECLAMPSIA, AND A

605
00:20:16,405 --> 00:20:18,240
SUBSTANTIAL NUMBER, OVER 6,000

606
00:20:18,240 --> 00:20:20,209
REQUIRE ADMISSION TO AN ICU

607
00:20:20,209 --> 00:20:23,846
DURING THE PREGNANCY OR DELIVERY

608
00:20:23,846 --> 00:20:26,415
HOSPITALIZATION, AND ABOUT 754

609
00:20:26,415 --> 00:20:34,790
MATERNAL DEATHS.

610
00:20:34,790 --> 00:20:37,860
IF WE LOOK OVER TIME WE SEE

611
00:20:37,860 --> 00:20:39,595
CONSISTENT INCREASES, SHOWN HERE

612
00:20:39,595 --> 00:20:41,797
FROM 2007 TO 2019, AND FOR

613
00:20:41,797 --> 00:20:43,232
GESTATIONAL DIABETES SHOWN HERE

614
00:20:43,232 --> 00:20:45,067
FROM 2011 TO 2019.

615
00:20:45,067 --> 00:20:46,969
IF WE LOOK BASED ON

616
00:20:46,969 --> 00:20:47,903
SELF-IDENTIFIED RACE AND

617
00:20:47,903 --> 00:20:49,672
ETHNICITY, WE SEE THE HIGHEST

618
00:20:49,672 --> 00:20:51,640
RATES FOR HYPERTENSIVE DISORDERS

619
00:20:51,640 --> 00:20:53,075
AMONG NON-HISPANIC BLACK

620
00:20:53,075 --> 00:20:54,610
INDIVIDUALS AND THE HIGHEST RATE

621
00:20:54,610 --> 00:20:58,214
FOR GESTATIONAL DIABETES AMONG

622
00:20:58,214 --> 00:21:05,387
NON-HISPANIC ASIAN INDIVIDUALS.

623
00:21:05,387 --> 00:21:06,288
ONE OF THE KEY QUESTIONS THAT

624
00:21:06,288 --> 00:21:07,923
OFTEN COMES UP WHEN WE LOOK AT

625
00:21:07,923 --> 00:21:08,791
THESE INCREASING TRENDS IS, IS

626
00:21:08,791 --> 00:21:09,992
PART OF THE REASON THAT WE'RE

627
00:21:09,992 --> 00:21:11,527
SEEING THESE PATTERNS AND

628
00:21:11,527 --> 00:21:13,696
INCREASES BECAUSE OF INCREASING

629
00:21:13,696 --> 00:21:19,301
MATERNAL AGE IN OUR POPULATION?

630
00:21:19,301 --> 00:21:21,403
SO IF WE TAKE A LOOK AT THE

631
00:21:21,403 --> 00:21:22,838
MATERNAL AGE DISTRIBUTION OVER

632
00:21:22,838 --> 00:21:25,241
TIME, PARTICULARLY BETWEEN 2007

633
00:21:25,241 --> 00:21:27,209
AND 2019, YOU CAN SEE HERE IN

634
00:21:27,209 --> 00:21:29,044
THIS COLOR-CODED DIAGRAM THAT

635
00:21:29,044 --> 00:21:30,913
WHILE THE MEAN AGE HAS INCREASED

636
00:21:30,913 --> 00:21:32,448
BY TWO YEARS, THE MAJORITY OF

637
00:21:32,448 --> 00:21:33,882
THAT INCREASE HAS ACTUALLY COME

638
00:21:33,882 --> 00:21:35,751
FROM A POSITIVE OR FAVORABLE

639
00:21:35,751 --> 00:21:37,152
DECLINE IN TEEN BIRTHS.

640
00:21:37,152 --> 00:21:39,855
SO THERE'S BEEN SOME SHIFT WITH

641
00:21:39,855 --> 00:21:41,056
GREATER BIRTHS OCCURRING IN THE

642
00:21:41,056 --> 00:21:46,729
30 TO 34 OR THAT KNEE ON GREEN N

643
00:21:46,729 --> 00:21:48,631
GREEN SHADED REGION, BUT A LOT

644
00:21:48,631 --> 00:21:51,800
OF THIS CHAIJ HAS COME FROM A

645
00:21:51,800 --> 00:21:52,434
FAVORABLE AGE DISTRIBUTION

646
00:21:52,434 --> 00:21:54,503
CHANGE.

647
00:21:54,503 --> 00:21:56,405
WHILE AGE IS INDEED A RELATIVE

648
00:21:56,405 --> 00:21:58,240
RISK FACTOR, WHEREBY OLDER AGE

649
00:21:58,240 --> 00:21:59,875
IS ASSOCIATED WITH HIGHER RISK

650
00:21:59,875 --> 00:22:02,177
OF HYPERTENSIVE DISORDERS OF

651
00:22:02,177 --> 00:22:03,379
PREGNANCY, IF WE LOOK AT THIS

652
00:22:03,379 --> 00:22:05,214
FROM AN ABSOLUTE FRAMEWORK, WE

653
00:22:05,214 --> 00:22:07,750
CAN SEE FROM THIS PIE CHART THAT

654
00:22:07,750 --> 00:22:12,121
NEARLY 50% OF CASES OF NEW ONSET

655
00:22:12,121 --> 00:22:13,322
HYPERTENSIVE DISORDERS ACTUALLY

656
00:22:13,322 --> 00:22:15,624
OCCURRED IN INDIVIDUALS AGED 20

657
00:22:15,624 --> 00:22:16,925
TO 29, SO THE PURPLE AND THE

658
00:22:16,925 --> 00:22:18,227
GREEN COLOR HERE.

659
00:22:18,227 --> 00:22:19,561
AND THAT REPRESENTS THAT A

660
00:22:19,561 --> 00:22:20,896
GREATER PROPORTION OF

661
00:22:20,896 --> 00:22:22,164
PREGNANCIES ARE OCCURRING IN

662
00:22:22,164 --> 00:22:23,932
THIS AGE RANGE, BUT IT

663
00:22:23,932 --> 00:22:26,468
HIGHLIGHTS THE IMPORTANCE OF WHO

664
00:22:26,468 --> 00:22:30,639
MAY NORMALLY BE QUALIFIED AS NOT

665
00:22:30,639 --> 00:22:33,242
GREATER THAN -- OR ADVANCED

666
00:22:33,242 --> 00:22:34,543
MATERNAL AGE REALLY EXPERIENCING

667
00:22:34,543 --> 00:22:35,678
A LARGE PROPORTION OF THE

668
00:22:35,678 --> 00:22:38,647
ABSOLUTE BURDEN.

669
00:22:38,647 --> 00:22:42,685
ANOTHER WAY TO LOOK AT THIS IS

670
00:22:42,685 --> 00:22:44,320
RELATED TO BIRTH COHORT EFFECTS.

671
00:22:44,320 --> 00:22:46,088
SO IF WE THINK ABOUT THE FACT

672
00:22:46,088 --> 00:22:49,358
THAT OVER TIME, INDIVIDUALS

673
00:22:49,358 --> 00:22:50,893
WHILE THE ACTUAL AGE AT WHICH

674
00:22:50,893 --> 00:22:52,561
THEY'RE GIVING BIRTH IS THE SAME

675
00:22:52,561 --> 00:22:54,396
BUT THEY THEMSELVES WERE BORN IN

676
00:22:54,396 --> 00:22:56,498
A LATER PERIOD, SO IF SOMEBODY

677
00:22:56,498 --> 00:22:59,668
WAS BORN BETWEEN 1996 TO 2004

678
00:22:59,668 --> 00:23:01,737
SHOWN HERE IN THE DARK BLUE,

679
00:23:01,737 --> 00:23:04,807
VERSUS SOMEBODY WHO WAS BORN IN

680
00:23:04,807 --> 00:23:06,909
AN EARLIER BIRTH COHORT, YOU CAN

681
00:23:06,909 --> 00:23:08,444
SEE BY THESE OVERLAPPING STACKED

682
00:23:08,444 --> 00:23:10,946
LINES THAT INDIVIDUALS BORN IN

683
00:23:10,946 --> 00:23:14,817
MORE RECENT GENERATIONS, 1996 TO

684
00:23:14,817 --> 00:23:17,319
2004 IN THE ORANGE, 1991 TO

685
00:23:17,319 --> 00:23:19,388
1999, ARE MUCH MORE LIKELY TO

686
00:23:19,388 --> 00:23:20,723
EXPERIENCE A HYPERTENSIVE

687
00:23:20,723 --> 00:23:23,692
DISORDER OF PREGNANCY EVEN AT

688
00:23:23,692 --> 00:23:26,095
THE SAME AGE AT DELIVERY.

689
00:23:26,095 --> 00:23:27,663
AND THIS REALLY HIGHLIGHTS THAT

690
00:23:27,663 --> 00:23:29,298
THERE'S AN ADDITIONAL BIRTH

691
00:23:29,298 --> 00:23:30,999
COHORT EFFECT THAT MAY BE

692
00:23:30,999 --> 00:23:33,535
RELATED TO SECULAR TRENDS OR

693
00:23:33,535 --> 00:23:35,337
POPULATION SHIFTS THAT HELP US

694
00:23:35,337 --> 00:23:37,306
BETTER UNDERSTAND THAT THIS IS

695
00:23:37,306 --> 00:23:39,241
NOT ALL SPECIFICALLY RELATED TO

696
00:23:39,241 --> 00:23:41,543
AGE OR PERIOD EFFECT, BUT BETTER

697
00:23:41,543 --> 00:23:43,078
UNDERSTANDING WHAT MAY BE

698
00:23:43,078 --> 00:23:44,813
CHANGING IN BIRTH COHORTS FOR

699
00:23:44,813 --> 00:23:46,348
PREGNANT INDIVIDUALS THEMSELVES.

700
00:23:46,348 --> 00:23:49,852
SO WHAT MIGHT THAT BE?

701
00:23:49,852 --> 00:23:51,520
SO LET'S TALK A LITTLE BIT ABOUT

702
00:23:51,520 --> 00:23:53,822
THE RATIONALE FOR CARDIOVASCULAR

703
00:23:53,822 --> 00:23:56,425
HEALTH PROMOTION AS PERHAPS THAT

704
00:23:56,425 --> 00:23:57,426
ANTECEDENT DRIVER TO WHAT'S

705
00:23:57,426 --> 00:23:59,661
CHANGING IN THE POPULATION AND

706
00:23:59,661 --> 00:24:02,898
OPPORTUNITIES TO INTERVENE.

707
00:24:02,898 --> 00:24:05,334
SO IF WE GO BACK TO OUR

708
00:24:05,334 --> 00:24:06,969
CONCEPTUAL DIAGRAM, WE'VE GONE

709
00:24:06,969 --> 00:24:08,771
THROUGH THE ADVERSE PREGNANCY

710
00:24:08,771 --> 00:24:09,538
OUT COME COMPLICATIONS.

711
00:24:09,538 --> 00:24:12,541
WE'VE LOOKED AT POSTPARTUM

712
00:24:12,541 --> 00:24:13,542
CARDIOVASCULAR DISEASE RISK SO

713
00:24:13,542 --> 00:24:15,444
LET'S SHIFT UPSTREAM.

714
00:24:15,444 --> 00:24:17,813
AND TALK ABOUT PREPREGNANCY

715
00:24:17,813 --> 00:24:19,681
CARDIOVASCULAR HEALTH, WHICH ARE

716
00:24:19,681 --> 00:24:22,151
RISK FACTORS FOR SHORT-TERM

717
00:24:22,151 --> 00:24:24,353
MATERNAL MORBIDITY AND MORTALITY

718
00:24:24,353 --> 00:24:26,121
AND LONG TERM MORBIDITY AND

719
00:24:26,121 --> 00:24:28,957
MORTALITY.

720
00:24:28,957 --> 00:24:31,160
SO WHAT DATA DO WE HAVE FOR

721
00:24:31,160 --> 00:24:32,294
PREPREGNANCY CARDIOVASCULAR

722
00:24:32,294 --> 00:24:33,695
HEALTH AND ADVERSE PREGNANCY

723
00:24:33,695 --> 00:24:34,029
OUTCOMES?

724
00:24:34,029 --> 00:24:36,098
THESE ARE DATA FROM THE NATIONAL

725
00:24:36,098 --> 00:24:38,967
CENTER FOR HEALTH STATISTICS,

726
00:24:38,967 --> 00:24:40,702
WHEREBY BIRTH CERTIFICATES WERE

727
00:24:40,702 --> 00:24:43,605
REVIEWED TO LOOK AT MATERNAL

728
00:24:43,605 --> 00:24:44,773
CHARACTERISTICS, SPECIFICALLY A

729
00:24:44,773 --> 00:24:46,341
CVH SCORE WAS CHARACTERIZED

730
00:24:46,341 --> 00:24:48,710
BASED ON OBESITY, DIABETES

731
00:24:48,710 --> 00:24:50,012
STATUS, HYPERTENSION STATUS AND

732
00:24:50,012 --> 00:24:51,113
SMOKING STATUS.

733
00:24:51,113 --> 00:24:55,918
SO A SCORE OF ZERO MEANT POOR

734
00:24:55,918 --> 00:24:57,252
CARDIOVASCULAR HEALTH WITH A

735
00:24:57,252 --> 00:24:58,487
GRADED DOSE DEPENDENT RESPONSE

736
00:24:58,487 --> 00:25:00,556
ASSOCIATED WITH GREATER RISK OF

737
00:25:00,556 --> 00:25:01,423
ADVERSE PREGNANCY OUTCOMES WITH

738
00:25:01,423 --> 00:25:02,958
A HIGHER BURDEN OF THESE RISK

739
00:25:02,958 --> 00:25:04,927
FACTORS, AND THAT WAS SEEN FROM

740
00:25:04,927 --> 00:25:06,662
MATERNAL ICU ADMISSION, PRETERM

741
00:25:06,662 --> 00:25:11,033
BIRTH AND LOW BIRTH WEIGHT.

742
00:25:11,033 --> 00:25:13,569
IN ADDITION TO THESE MORE CRUDE

743
00:25:13,569 --> 00:25:15,304
RISK FACTORS, THIS ANALYSIS FROM

744
00:25:15,304 --> 00:25:18,040
THE NEW MOM TO BE STUDY LOOKED

745
00:25:18,040 --> 00:25:20,142
SPECIFICALLY AT BLOOD PRESSURE

746
00:25:20,142 --> 00:25:21,543
LEVELS, EVEN IN THE ABSENCE OF

747
00:25:21,543 --> 00:25:23,846
CHRONIC HYPERTENSION REQUIRING

748
00:25:23,846 --> 00:25:25,380
MEDICATION, AND WHAT THE

749
00:25:25,380 --> 00:25:27,883
ASSOCIATION WITH COMPLICATIONS

750
00:25:27,883 --> 00:25:29,852
OF PREECLAMPSIA AND BIRTH

751
00:25:29,852 --> 00:25:30,752
COMPLICATIONS DURING PREGNANCY

752
00:25:30,752 --> 00:25:31,286
WAS.

753
00:25:31,286 --> 00:25:33,589
YOU CAN SEE IN THE CATEGORIES

754
00:25:33,589 --> 00:25:36,892
HERE ABOUT 10% OF INDIVIDUALS

755
00:25:36,892 --> 00:25:38,427
QUALIFIED IN THE STAGE ONE

756
00:25:38,427 --> 00:25:39,962
HYPERTENSION CATEGORY, ABOUT 10%

757
00:25:39,962 --> 00:25:41,597
HAD ELEVATED BLOOD PRESSURE, AND

758
00:25:41,597 --> 00:25:43,232
THE MAJORITY HAD NORMAL BLOOD

759
00:25:43,232 --> 00:25:43,899
PRESSURE.

760
00:25:43,899 --> 00:25:46,301
AND SO YOU CAN ALREADY SEE THE

761
00:25:46,301 --> 00:25:48,370
SEPARATION BASED ON HAVING AN

762
00:25:48,370 --> 00:25:50,038
ELEVATED OR STAGE ONE

763
00:25:50,038 --> 00:25:51,907
HYPERTENSION BLOOD PRESSURE IN

764
00:25:51,907 --> 00:25:53,375
EARLY PREGNANCY AT A MEAN

765
00:25:53,375 --> 00:25:54,643
GESTATIONAL AGE OF 12 WEEKS WITH

766
00:25:54,643 --> 00:25:58,480
A HIGHER RISK OF PRE-ECLAMPSIA

767
00:25:58,480 --> 00:25:59,581
NOW WHEN GESTATIONAL

768
00:25:59,581 --> 00:26:03,385
HYPERTENSION WAS ADDED THERE WAS

769
00:26:03,385 --> 00:26:05,521
EVEN A HIGHER ONE IN THREE RISK

770
00:26:05,521 --> 00:26:07,589
OF DEVELOPING EITHER GESTATIONAL

771
00:26:07,589 --> 00:26:09,024
HYPERTENSION OR PREECLAMPSIA AND

772
00:26:09,024 --> 00:26:10,659
THOSE IN THE STAGE ONE GROUP HAD

773
00:26:10,659 --> 00:26:14,396
A 40% INCIDENCE OF DEVELOPING

774
00:26:14,396 --> 00:26:17,165
EITHER GESTATIONAL HYPERTENSION

775
00:26:17,165 --> 00:26:18,133
OR PRE-ECLAMPSIA THE OTHER

776
00:26:18,133 --> 00:26:18,901
INTERESTING THING WAS AMONG

777
00:26:18,901 --> 00:26:20,168
THOSE WHO HAD AN INCREASE IN

778
00:26:20,168 --> 00:26:21,503
BLOOD PRESSURE FROM THIS FIRST

779
00:26:21,503 --> 00:26:22,871
TRIMESTER TO SECOND TRIMESTER

780
00:26:22,871 --> 00:26:24,840
VISIT WERE MUCH MORE LIKELY TO

781
00:26:24,840 --> 00:26:26,742
DEVELOP PREECLAMPSIA AS WELL,

782
00:26:26,742 --> 00:26:28,577
HIGHLIGHTING THE DYNAMIC NATURE

783
00:26:28,577 --> 00:26:29,678
OF BLOOD PRESSURE CHANGE DURING

784
00:26:29,678 --> 00:26:30,979
PREGNANCY AS AN IMPORTANT

785
00:26:30,979 --> 00:26:35,951
PREDICTOR.

786
00:26:35,951 --> 00:26:38,120
WHILE THESE DATA HELP US

787
00:26:38,120 --> 00:26:40,322
IDENTIFY THAT PREPREGNANCY

788
00:26:40,322 --> 00:26:44,159
CARDIOVASCULAR HELP AS WELL

789
00:26:44,159 --> 00:26:45,694
AS -- ARE REALLY IMPORTANT FOR

790
00:26:45,694 --> 00:26:47,029
PREGNANCY COMPLICATION AND LONG

791
00:26:47,029 --> 00:26:48,397
TERM CARDIOVASCULAR RISK, IF WE

792
00:26:48,397 --> 00:26:50,832
TAKE A LOOK AT THE OVERALL

793
00:26:50,832 --> 00:26:52,234
POPULATION CHANGE, WE SEE

794
00:26:52,234 --> 00:26:53,468
CARDIOVASCULAR HEALTH IS

795
00:26:53,468 --> 00:26:54,536
DECLINING OVERALL IN ALL

796
00:26:54,536 --> 00:26:55,070
INDIVIDUALS.

797
00:26:55,070 --> 00:26:58,273
RATES OF OBESITY AND SEVERE

798
00:26:58,273 --> 00:27:00,075
OBESITY ARE INCREASING, RATES OF

799
00:27:00,075 --> 00:27:02,044
PREDIABETES AND DIABETES, AND

800
00:27:02,044 --> 00:27:02,978
PARTICULARLY AMONG ADOLESCENTS

801
00:27:02,978 --> 00:27:04,980
AND YOUNG ADULTS, WHO ARE IN

802
00:27:04,980 --> 00:27:09,017
THEIR REPRODUCTIVE YEARS.

803
00:27:09,017 --> 00:27:10,018
DATA FROM THE NATIONAL CENTER

804
00:27:10,018 --> 00:27:11,787
FOR HEALTH STATISTICS HELPS US

805
00:27:11,787 --> 00:27:13,188
ALSO LOOK AT SOME OF THESE

806
00:27:13,188 --> 00:27:15,924
TRENDS WHEREBY IN EACH AGE

807
00:27:15,924 --> 00:27:17,626
GROUP, SHOWN HERE FOR 15 TO 24,

808
00:27:17,626 --> 00:27:20,996
25 TO 34 AND 35 TO 44, WE SEE A

809
00:27:20,996 --> 00:27:22,431
DECLINE IN OPTIMAL

810
00:27:22,431 --> 00:27:23,832
CARDIOVASCULAR HEALTH, WHEREBY

811
00:27:23,832 --> 00:27:26,802
OPTIMAL IS DEFINED AS NORMAL

812
00:27:26,802 --> 00:27:28,136
BMI, ABSENCE OF DIABETES OR

813
00:27:28,136 --> 00:27:29,037
HYPERTENSION.

814
00:27:29,037 --> 00:27:30,205
IN THE SECOND FIGURE, WE SEE

815
00:27:30,205 --> 00:27:32,608
THAT THERE ARE ALSO SIGNIFICANT

816
00:27:32,608 --> 00:27:34,476
DISPARITIES BY ADVERSE SOCIAL

817
00:27:34,476 --> 00:27:36,445
FACTORS AS DESIGNATED BY

818
00:27:36,445 --> 00:27:40,082
QUALIFYING OR RECEIVING WIC

819
00:27:40,082 --> 00:27:40,782
SUPPORT DURING PREGNANCY.

820
00:27:40,782 --> 00:27:42,985
YOU SEE THAT SIGNIFICANT

821
00:27:42,985 --> 00:27:44,920
DIFFERENCE IN OPTIMAL CVH IN

822
00:27:44,920 --> 00:27:46,888
THOSE RECEIVING WIC SUPPORT AS

823
00:27:46,888 --> 00:27:48,256
WELL AS CONSISTENT DECLINES FOR

824
00:27:48,256 --> 00:27:51,660
BOTH.

825
00:27:51,660 --> 00:27:53,595
SO I POSIT AND HOPEFULLY WHAT

826
00:27:53,595 --> 00:27:55,130
WE'VE LOOKED AT SO FAR

827
00:27:55,130 --> 00:27:56,198
HIGHLIGHTS THAT MATERNAL

828
00:27:56,198 --> 00:27:57,265
MORBIDITY IS REALLY THE TIP OF

829
00:27:57,265 --> 00:27:59,334
THE ICEBERG WHEN WE'RE THINKING

830
00:27:59,334 --> 00:28:02,337
ABOUT BOTH PREGNANCY-SPECIFIC

831
00:28:02,337 --> 00:28:03,739
COMPLICATIONS AND LONG TERM

832
00:28:03,739 --> 00:28:05,374
CARDIOVASCULAR HEALTH.

833
00:28:05,374 --> 00:28:07,476
AND REALLY WHAT WE WANT TO DO IS

834
00:28:07,476 --> 00:28:08,810
MOVE BELOW THE SURFACE TO THINK

835
00:28:08,810 --> 00:28:10,779
ABOUT THE GREATER POPULATION

836
00:28:10,779 --> 00:28:12,180
LEVEL IMPACT THAT WE CAN HAVE

837
00:28:12,180 --> 00:28:14,116
WITH A FOCUS ON CARDIOVASCULAR

838
00:28:14,116 --> 00:28:15,817
HEALTH THROUGHOUT THE PERIPARTUM

839
00:28:15,817 --> 00:28:21,723
PERIOD.

840
00:28:21,723 --> 00:28:24,259
AHA, ACC AND ACOG HAVE ALL

841
00:28:24,259 --> 00:28:26,128
HIGHLIGHTED THE REPRODUCTIVE

842
00:28:26,128 --> 00:28:27,996
YEARS AS AN IMPORTANT PERIOD TO

843
00:28:27,996 --> 00:28:34,102
FOCUS ON CARDIOVASCULAR HEALTH

844
00:28:34,102 --> 00:28:37,172
PROMOTION, AND AN AHA/ACOG

845
00:28:37,172 --> 00:28:38,040
COMBINED PRESIDENTIAL ADVISORY

846
00:28:38,040 --> 00:28:39,708
THAT PROMOTED RISK

847
00:28:39,708 --> 00:28:41,009
IDENTIFICATION AND REDUCTION OF

848
00:28:41,009 --> 00:28:41,910
CARDIOVASCULAR DISEASE DURING

849
00:28:41,910 --> 00:28:44,980
THE REPRODUCTIVE YEARS.

850
00:28:44,980 --> 00:28:47,149
ONE OF THE KEY PHRASES THAT HAS

851
00:28:47,149 --> 00:28:48,483
BECOME MORE AND MORE COMMON IS

852
00:28:48,483 --> 00:28:50,786
THIS IDEA OF A FOURTH TRIMESTER,

853
00:28:50,786 --> 00:28:52,754
THE 12 WEEKS THAT FOLLOW

854
00:28:52,754 --> 00:28:54,189
DELIVERY, AS A KEY TIME FOR

855
00:28:54,189 --> 00:28:55,824
THOSE WHO HAVE DELIVERY

856
00:28:55,824 --> 00:28:57,559
COMPLICATED BY ADVERSE PREGNANCY

857
00:28:57,559 --> 00:29:00,228
OUTCOMES TO BE CONNECTED TO AND

858
00:29:00,228 --> 00:29:02,164
TRANSITION TO PRIMARY CARE.

859
00:29:02,164 --> 00:29:03,932
THIS NICE SCHEMATIC FROM A

860
00:29:03,932 --> 00:29:05,801
RECENT REVIEW IN JAMA CARDIOLOGY

861
00:29:05,801 --> 00:29:07,436
HIGHLIGHTED THIS GROWING CONCEPT

862
00:29:07,436 --> 00:29:10,305
OF TRANSITIONAL CLINICS THAT CAN

863
00:29:10,305 --> 00:29:11,840
PERFORM EDUCATION, COUNSELING,

864
00:29:11,840 --> 00:29:14,476
SCREENING AND RISK ASSESSMENT,

865
00:29:14,476 --> 00:29:17,012
MEDICATION MANAGEMENT AND THAT

866
00:29:17,012 --> 00:29:17,879
IMPORTANT TRANSITION TO PRIMARY

867
00:29:17,879 --> 00:29:18,880
CARE FOR INDIVIDUALS WHO ARE

868
00:29:18,880 --> 00:29:20,082
IDENTIFIED AS HAVING HIGHER RISK

869
00:29:20,082 --> 00:29:22,250
DUE TO THEIR COMPLICATION OF

870
00:29:22,250 --> 00:29:25,120
ADVERSE PREGNANCY OUT COME.

871
00:29:25,120 --> 00:29:26,188
 OUTCOME.

872
00:29:26,188 --> 00:29:28,523
ONE OF THE CHALLENGES WITH THIS

873
00:29:28,523 --> 00:29:30,258
CONSTRUCTION HAS BEEN THE

874
00:29:30,258 --> 00:29:32,494
INABILITY FOR INDIVIDUALS TO

875
00:29:32,494 --> 00:29:33,895
COME IN IN PERSON, ESPECIALLY

876
00:29:33,895 --> 00:29:37,332
WITH THE COVID PANDEMIC, THE

877
00:29:37,332 --> 00:29:39,735
INCREASING USE OF TELEHEALTH

878
00:29:39,735 --> 00:29:41,603
MADE DIAGRAMS OR CONSTRUCTS LIKE

879
00:29:41,603 --> 00:29:42,904
THIS MORE AVAILABLE.

880
00:29:42,904 --> 00:29:44,973
THIS WAS A REPORT THAT WAS

881
00:29:44,973 --> 00:29:47,008
PUBLISHED FROM A ACADEMIC CENTER

882
00:29:47,008 --> 00:29:49,745
THAT INCORPORATED A

883
00:29:49,745 --> 00:29:50,345
MULTIDISCIPLINARY TELEHEALTH

884
00:29:50,345 --> 00:29:52,214
CLINIC TO ALLOW INDIVIDUALS TO

885
00:29:52,214 --> 00:29:55,117
BE ABLE TO GO HOME SOONER WITH

886
00:29:55,117 --> 00:29:57,085
HOME BLOOD PRESSURE MONITORING

887
00:29:57,085 --> 00:29:59,921
PROGRAMS, AS WELL AS STAY IN AN

888
00:29:59,921 --> 00:30:00,922
EXTENDED HOME BLOOD PRESSURE

889
00:30:00,922 --> 00:30:02,157
MONITORING PROGRAM POSTPARTUM TO

890
00:30:02,157 --> 00:30:03,959
CONTINUE TO MONITOR CLOSELY FOR

891
00:30:03,959 --> 00:30:04,659
BLOOD PRESSURE COMPARED WITH THE

892
00:30:04,659 --> 00:30:06,094
STAN

893
00:30:06,094 --> 00:30:07,662
STANDARD OF CARE WHICH AFTER

894
00:30:07,662 --> 00:30:09,097
THAT FIRST 14 DAY BLOOD PRESSURE

895
00:30:09,097 --> 00:30:11,366
CHECK MAY HAVE LEFT WITH

896
00:30:11,366 --> 00:30:12,134
SOMETHING -- WITH THE CLINIC

897
00:30:12,134 --> 00:30:14,035
VISIT SOMEWHERE IN THE 2 TO

898
00:30:14,035 --> 00:30:15,237
6 MONTH PERIOD AND REALLY A LOT

899
00:30:15,237 --> 00:30:17,105
OF PEOPLE GETTING LOST AND NOT

900
00:30:17,105 --> 00:30:21,710
HAVING FOLLOW-UP.

901
00:30:21,710 --> 00:30:24,246
IT'S REALLY IMPORTANT TO THINK

902
00:30:24,246 --> 00:30:25,247
ABOUT AMONG INDIVIDUALS WHO

903
00:30:25,247 --> 00:30:26,314
EXPERIENCE A HYPERTENSIVE

904
00:30:26,314 --> 00:30:28,049
DISORDER OF PREGNANCY, MANY NO

905
00:30:28,049 --> 00:30:30,152
LONGER NEED MEDICATIONS, AND MAY

906
00:30:30,152 --> 00:30:32,554
NOT BE CLOSELY FOLLOWED FOR

907
00:30:32,554 --> 00:30:34,656
OPTIMAL LIFESTYLE INTERVENTIONS.

908
00:30:34,656 --> 00:30:36,358
SO THIS REALLY NICE WORK THAT

909
00:30:36,358 --> 00:30:40,362
WAS FUNDED BY NHLBI ASKED THE

910
00:30:40,362 --> 00:30:42,230
QUESTION OF TEXT-BASED

911
00:30:42,230 --> 00:30:43,365
GAMIFICATION, SO COULD WE

912
00:30:43,365 --> 00:30:45,667
PROMOTE PHYSICAL ACTIVITY IN A

913
00:30:45,667 --> 00:30:47,402
GAMIFIED APPROACH TO HELP

914
00:30:47,402 --> 00:30:48,503
IMPROVE STEP COUNTS?

915
00:30:48,503 --> 00:30:51,573
SO THE STUDY LOOKED AT 127

916
00:30:51,573 --> 00:30:53,542
PARTICIPANTS WITH A MEAN AGE OF

917
00:30:53,542 --> 00:30:55,610
32 WHO HAD EXPERIENCED A

918
00:30:55,610 --> 00:30:56,411
HYPERTENSIVE DISORDER OF

919
00:30:56,411 --> 00:30:58,947
PREGNANCY AND RANDOMIZED THEM TO

920
00:30:58,947 --> 00:31:00,916
A TEXT-BASED GAMIFICATION

921
00:31:00,916 --> 00:31:03,218
APPROACH WHERE BOTH CONTROL AND

922
00:31:03,218 --> 00:31:05,220
INTERVENTION RECEIVED A FITBIT

923
00:31:05,220 --> 00:31:06,421
TO TRACK THEIR STEP COUNTS, AND

924
00:31:06,421 --> 00:31:08,089
YOU SEE HERE THAT THE

925
00:31:08,089 --> 00:31:08,957
INTERVENTION SHOWN IN THE DARK

926
00:31:08,957 --> 00:31:10,525
RED HAD A MUCH HIGHER STEP COUNT

927
00:31:10,525 --> 00:31:12,060
THAN THE CONTROL.

928
00:31:12,060 --> 00:31:13,562
NOW, I ALSO DO WANT TO POINT OUT

929
00:31:13,562 --> 00:31:17,566
THAT THE DELTA HERE WAS ABOUT

930
00:31:17,566 --> 00:31:18,867
600 STEPS, WHICH IS ABOUT A

931
00:31:18,867 --> 00:31:20,969
THIRD OF A MILE OR ON AN AVERAGE

932
00:31:20,969 --> 00:31:22,070
WALKING PACE ABOUT FIVE MINUTES

933
00:31:22,070 --> 00:31:23,772
OF WALKING EXTRA PER DAY.

934
00:31:23,772 --> 00:31:25,340
NOW, WHILE THAT MAY NOT SEEM

935
00:31:25,340 --> 00:31:27,943
LIKE A LOT, THE COMBINATION OF

936
00:31:27,943 --> 00:31:30,412
DOING THAT ON A FREQUENT AND

937
00:31:30,412 --> 00:31:33,081
CONTINUOUS BASIS MAY HAVE

938
00:31:33,081 --> 00:31:34,482
LONG-STANDING EFFECT, BUT I

939
00:31:34,482 --> 00:31:35,350
THINK ONE OF THE CHALLENGE THAT

940
00:31:35,350 --> 00:31:38,286
WE CONTINUE TO HAVE IS HOW DO WE

941
00:31:38,286 --> 00:31:40,255
SUSTAIN INCREASES AND MAINTAIN

942
00:31:40,255 --> 00:31:43,358
PHYSICAL ACTIVITY IN BIRTHING

943
00:31:43,358 --> 00:31:47,762
ADULTS AS WELL AS ALL ADULTS.

944
00:31:47,762 --> 00:31:49,798
ONE OF THE OTHER STRATEGIES THAT

945
00:31:49,798 --> 00:31:51,900
HAS BEEN PROMOTED HAS BEEN THE

946
00:31:51,900 --> 00:31:54,469
SUPPORT OF LACTATION TO PROMOTE

947
00:31:54,469 --> 00:31:56,438
METABOLIC HEALTH POSTPARTUM.

948
00:31:56,438 --> 00:31:57,706
THE FIRST GRAPH HERE SHOWS SOME

949
00:31:57,706 --> 00:32:02,244
REALLY NICE DATA FROM THE CARDIA

950
00:32:02,244 --> 00:32:05,080
COHORT, LOOKING AT DURATION OF

951
00:32:05,080 --> 00:32:06,948
LACTATION FROM NONE TO GREATER

952
00:32:06,948 --> 00:32:08,950
THAN ZERO TO SIX MONTHS, 6 TO

953
00:32:08,950 --> 00:32:11,786
12, GREATER THAN OR EQUAL TO 12,

954
00:32:11,786 --> 00:32:13,655
AND COMBINED WITH ANY

955
00:32:13,655 --> 00:32:14,456
LACTATION -- OR COMBINED WITH

956
00:32:14,456 --> 00:32:17,325
THE OVERALL POPULATION TO LOOK

957
00:32:17,325 --> 00:32:19,527
AT THE INCIDENCE OF DIABETES IN

958
00:32:19,527 --> 00:32:21,463
FOLLOW-UP, AND YOU CAN SEE THOSE

959
00:32:21,463 --> 00:32:24,332
INDIVIDUALS THAT HAD GREATER

960
00:32:24,332 --> 00:32:25,767
DURATION OF LACTATION HAVE LOWER

961
00:32:25,767 --> 00:32:27,535
INCIDENCE OF DIABETES, AND WHEN

962
00:32:27,535 --> 00:32:29,471
YOU STRATIFY BY GESTATIONAL

963
00:32:29,471 --> 00:32:30,972
DIABETES OR NON-GESTATIONAL

964
00:32:30,972 --> 00:32:32,574
DIABETES, YOU SEE A SIMILAR

965
00:32:32,574 --> 00:32:32,908
PATTERN.

966
00:32:32,908 --> 00:32:34,242
SO THERE IS AN EFFECT

967
00:32:34,242 --> 00:32:35,477
MODIFICATION BY GESTATIONAL

968
00:32:35,477 --> 00:32:36,044
DIABETES STATUS.

969
00:32:36,044 --> 00:32:38,213
SO THAT IS OBSERVATIONAL DATA

970
00:32:38,213 --> 00:32:41,950
THAT SUPPORTS AN ASSOCIATION.

971
00:32:41,950 --> 00:32:43,518
UNFORTUNATELY, GIVEN THE

972
00:32:43,518 --> 00:32:44,519
STRUCTURAL AND PERSONAL BARRIERS

973
00:32:44,519 --> 00:32:47,589
THAT MAY EXIST TO LACTATION, WE

974
00:32:47,589 --> 00:32:49,491
DO SEE VERY LOW RATES IN THE

975
00:32:49,491 --> 00:32:51,960
UNITED STATES WITH AT 6 MONTHS,

976
00:32:51,960 --> 00:32:55,130
ANY BREASTFEEDING AT ABOUT 56%

977
00:32:55,130 --> 00:32:57,165
AND EXCLUSIVE BREASTFEEDING AT

978
00:32:57,165 --> 00:32:59,834
25%.

979
00:32:59,834 --> 00:33:02,003
WE KNOW THERE ARE MANY BARRIERS

980
00:33:02,003 --> 00:33:05,106
THAT EXIST INCLUDING AT A POLICY

981
00:33:05,106 --> 00:33:07,208
LEVEL WITH NEED FOR PARENTAL

982
00:33:07,208 --> 00:33:10,512
LEAVE AT A COMMUNITY LEVEL,

983
00:33:10,512 --> 00:33:11,279
INSTITUTIONAL, INTERPERSONAL AND

984
00:33:11,279 --> 00:33:12,614
INDIVIDUAL LEVEL THAT CAN REALLY

985
00:33:12,614 --> 00:33:13,715
CREATE CHALLENGES FOR SUPPORTING

986
00:33:13,715 --> 00:33:15,784
LACTATION.

987
00:33:15,784 --> 00:33:16,885
UNDERSTANDING THESE CHALLENGES

988
00:33:16,885 --> 00:33:18,687
AND ADDRESSING THEM IN AN

989
00:33:18,687 --> 00:33:20,188
EQUITABLE FRAMEWORK SHOWN HERE

990
00:33:20,188 --> 00:33:23,758
AS A SOCIOECOLOGICAL MODEL THAT

991
00:33:23,758 --> 00:33:25,694
CAN REALLY THINK ABOUT THIS AT A

992
00:33:25,694 --> 00:33:27,095
POLICY LEVEL AND ORGANIZATIONAL

993
00:33:27,095 --> 00:33:28,096
LEVEL, COMMUNITY LEVEL, AS WELL

994
00:33:28,096 --> 00:33:28,997
AS INDIVIDUAL LEVEL S REALLY

995
00:33:28,997 --> 00:33:29,965
IMPORTANT.

996
00:33:29,965 --> 00:33:31,633
ONE OF THE THINGS THAT CAN OFTEN

997
00:33:31,633 --> 00:33:33,601
OCCUR WHEN WE TALK ABOUT

998
00:33:33,601 --> 00:33:35,136
LACTATION SUPPORT IS ALL OF THIS

999
00:33:35,136 --> 00:33:37,038
FOCUS THAT OCCURS ON THE

1000
00:33:37,038 --> 00:33:38,606
BIRTHING ADULT, WITHOUT

1001
00:33:38,606 --> 00:33:40,875
CONSIDERATION FOR THE EXTERNAL

1002
00:33:40,875 --> 00:33:42,510
DRIVERS THAT MAY BE OUT OF THEIR

1003
00:33:42,510 --> 00:33:44,746
CONTROL THAT CAN OFTEN

1004
00:33:44,746 --> 00:33:45,480
EXACERBATE AN ALREADY DIFFICULT

1005
00:33:45,480 --> 00:33:51,820
SITUATION.

1006
00:33:51,820 --> 00:33:53,588
SO WE'RE LOOKING AT A LOT OF

1007
00:33:53,588 --> 00:33:54,889
THIS DATA THAT HELP US IDENTIFY

1008
00:33:54,889 --> 00:33:56,691
THE POSTPARTUM PERIOD AS AN

1009
00:33:56,691 --> 00:33:58,893
IDEAL TIME TO MEASURE AND MODIFY

1010
00:33:58,893 --> 00:33:59,527
CARDIOVASCULAR HEALTH.

1011
00:33:59,527 --> 00:34:01,429
SO HOW CAN WE DO IT?

1012
00:34:01,429 --> 00:34:03,431
IN JAMA LAST YEAR, WE PROPOSED

1013
00:34:03,431 --> 00:34:05,934
LEVERAGING THE LIFE'S ESSENTIAL

1014
00:34:05,934 --> 00:34:07,168
8 FRAMEWORK, REALLY AS A

1015
00:34:07,168 --> 00:34:08,937
CONTINUOUS TIME THINKING ABOUT

1016
00:34:08,937 --> 00:34:09,904
THE PREPREGNANCY PERIOD, THE

1017
00:34:09,904 --> 00:34:12,007
PREGNANCY PERIOD, AND THE

1018
00:34:12,007 --> 00:34:14,142
POSTPARTUM PERIOD TO THINK ABOUT

1019
00:34:14,142 --> 00:34:16,544
MEASUREMENT AND MODIFICATION AS

1020
00:34:16,544 --> 00:34:18,847
NEEDED OF THESE EIGHT COMPONENTS

1021
00:34:18,847 --> 00:34:21,049
OF LIFE'S ESSENTIAL EIGHT,

1022
00:34:21,049 --> 00:34:22,484
SPECIFICALLY, DIETARY

1023
00:34:22,484 --> 00:34:25,220
ASSESSMENT, PHYSICAL ACTIVITY,

1024
00:34:25,220 --> 00:34:27,655
NICOTINE EXPOSURE AND AVOIDANCE,

1025
00:34:27,655 --> 00:34:29,691
SLEEP HEALTH, WHICH WAS THE

1026
00:34:29,691 --> 00:34:32,694
NEWEST VARIABLE THAT WAS

1027
00:34:32,694 --> 00:34:34,763
INCLUDED IN THE AHA

1028
00:34:34,763 --> 00:34:36,398
CARDIOVASCULAR HEALTH CONSTRUCT,

1029
00:34:36,398 --> 00:34:38,500
BODY MASS INDEX, BLOOD PRESSURE

1030
00:34:38,500 --> 00:34:39,634
MONITORING, BLOOD GLUCOSE AND

1031
00:34:39,634 --> 00:34:40,735
BLOOD LIPID SCREENING.

1032
00:34:40,735 --> 00:34:43,338
ONE OF THE THINGS THAT WE

1033
00:34:43,338 --> 00:34:44,072
HIGHLIGHTED WAS THE IMPORTANCE

1034
00:34:44,072 --> 00:34:45,440
OF DIET AND PHYSICAL ACTIVITY

1035
00:34:45,440 --> 00:34:46,875
SCREENING WITHIN THE CLINICAL

1036
00:34:46,875 --> 00:34:48,643
SYSTEM THAT IS OFTEN NOT COVERED

1037
00:34:48,643 --> 00:34:51,980
BOTH AT THE POSTPARTUM VISIT OR

1038
00:34:51,980 --> 00:34:54,182
IN TRANSITIONS TO PRIMARY CARE.

1039
00:34:54,182 --> 00:34:56,451
THE OTHER QUESTION THAT REMAINS

1040
00:34:56,451 --> 00:34:59,821
IS HOW FREQUENTLY SHOULD BLOOD

1041
00:34:59,821 --> 00:35:01,589
PRESSURE, BLOOD GLUCOSE AND

1042
00:35:01,589 --> 00:35:04,993
BLOOD LIPIDS BE MEASURED AFTER

1043
00:35:04,993 --> 00:35:07,295
AN INDIVIDUAL IS POSTPARTUM, HOW

1044
00:35:07,295 --> 00:35:09,264
SOON AFTER POSTPARTUM AND HOW

1045
00:35:09,264 --> 00:35:10,865
FREQUENTLY, AND SHOULD THAT

1046
00:35:10,865 --> 00:35:14,235
DIFFER FOR INDIVIDUALS WITH

1047
00:35:14,235 --> 00:35:15,437
ADVERSE POST PREGNANCY OUT COME,

1048
00:35:15,437 --> 00:35:16,971
GOING ON TO DEVELOP CHRONIC

1049
00:35:16,971 --> 00:35:20,475
HYPERTENSION AND DIABETES.

1050
00:35:20,475 --> 00:35:22,777
WHEN WE TALK ABOUT POSTPARTUM

1051
00:35:22,777 --> 00:35:23,545
INTERVENTIONS, IT'S IMPORTANT TO

1052
00:35:23,545 --> 00:35:25,180
REMEMBER THAT THESE COULD ALSO

1053
00:35:25,180 --> 00:35:27,215
SERVE AS INTERPREGNANCY

1054
00:35:27,215 --> 00:35:28,850
INTERVENTIONS, WHILE POSTPARTUM

1055
00:35:28,850 --> 00:35:31,019
MAY HELP TO MODIFY

1056
00:35:31,019 --> 00:35:32,020
CARDIOVASCULAR HEALTH ACROSS THE

1057
00:35:32,020 --> 00:35:34,155
LIFE COURSE FOR THE BIRTHING

1058
00:35:34,155 --> 00:35:35,457
INDIVIDUAL, OFTENTIMES PEOPLE

1059
00:35:35,457 --> 00:35:36,758
MAY BECOME PREGNANT AGAIN AND

1060
00:35:36,758 --> 00:35:41,796
THIS REPRESENTS AN END TERM

1061
00:35:41,796 --> 00:35:43,264
PREGNANCY INTERVENTION OR

1062
00:35:43,264 --> 00:35:44,099
PRETERM PREGNANCY INTERVENTION

1063
00:35:44,099 --> 00:35:45,233
FOR THE NEXT PREGNANCY.

1064
00:35:45,233 --> 00:35:46,434
NEXT SLIDE.

1065
00:35:46,434 --> 00:35:48,069
IT'S REALLY IMPORTANT WHEN WE

1066
00:35:48,069 --> 00:35:50,105
THINK ABOUT PREGNANCY

1067
00:35:50,105 --> 00:35:51,306
CARDIOVASCULAR HEALTH AND

1068
00:35:51,306 --> 00:35:52,640
POSTPARTUM CARDIOVASCULAR HEALTH

1069
00:35:52,640 --> 00:35:54,142
TO REMEMBER THAT THIS IS

1070
00:35:54,142 --> 00:35:56,277
SOMETHING THAT TRACKS VERY

1071
00:35:56,277 --> 00:35:57,912
CONSISTENTLY.

1072
00:35:57,912 --> 00:36:00,982
AND OFTENTIMES WHERE POSTPARTUM

1073
00:36:00,982 --> 00:36:02,851
CARDIOVASCULAR HEALTH IS, IS

1074
00:36:02,851 --> 00:36:04,786
REALLY DEFINED BY WHERE

1075
00:36:04,786 --> 00:36:05,620
PREGNANCY CARDIOVASCULAR HEALTH

1076
00:36:05,620 --> 00:36:07,822
IS, WHICH IS DEFINED BY

1077
00:36:07,822 --> 00:36:08,456
PREPREGNANCY CARDIOVASCULAR

1078
00:36:08,456 --> 00:36:11,459
HEALTH.

1079
00:36:11,459 --> 00:36:13,561
AND THIS WAS THE FOCUS OF A

1080
00:36:13,561 --> 00:36:15,430
RECENT AHA SCIENTIFIC STATEMENT

1081
00:36:15,430 --> 00:36:17,532
THAT I WAS FORTUNATE TO WORK ON

1082
00:36:17,532 --> 00:36:21,336
WITH DR. WEI FROM THE NHLBI AND

1083
00:36:21,336 --> 00:36:22,237
MANY OR COLLEAGUES THAT

1084
00:36:22,237 --> 00:36:23,571
HIGHLIGHTED THE IMPORTANCE OF

1085
00:36:23,571 --> 00:36:25,306
THE PREPREGNANCY PERIOD AS

1086
00:36:25,306 --> 00:36:26,875
PERHAPS THE ZERO TRIMESTER, A

1087
00:36:26,875 --> 00:36:27,842
PERIOD OF TIME WHERE WE MAY HAVE

1088
00:36:27,842 --> 00:36:29,644
THE GREATEST YIELD BY BEING ABLE

1089
00:36:29,644 --> 00:36:32,947
TO FOCUS ON OPTIMIZING

1090
00:36:32,947 --> 00:36:33,815
CARDIOVASCULAR HEALTH BEFORE AN

1091
00:36:33,815 --> 00:36:35,383
INDIVIDUAL BECOMES PREGNANT.

1092
00:36:35,383 --> 00:36:36,718
AND IF WE THINK ABOUT THIS

1093
00:36:36,718 --> 00:36:38,553
WITHIN THE LIFECYCLE OR FULL

1094
00:36:38,553 --> 00:36:40,188
LIFE COURSE, THE PREPREGNANCY

1095
00:36:40,188 --> 00:36:43,291
PERIOD REALLY INFORMS PREGNANCY

1096
00:36:43,291 --> 00:36:44,492
AND INTERPREGNANCY

1097
00:36:44,492 --> 00:36:45,493
CARDIOVASCULAR HEALTH AND FUTURE

1098
00:36:45,493 --> 00:36:46,928
RISK FOR CARDIOVASCULAR DISEASE

1099
00:36:46,928 --> 00:36:48,997
FOR THE BIRTHING INDIVIDUAL, AS

1100
00:36:48,997 --> 00:36:52,100
WELL AS THE IMPORTANCE OF

1101
00:36:52,100 --> 00:36:52,934
OFFSPRING CARDIOVASCULAR HEALTH

1102
00:36:52,934 --> 00:36:56,004
WHICH HAS ALSO BEEN DEMONSTRATED

1103
00:36:56,004 --> 00:36:57,338
IN OBSERVATIONAL COHORT STUDIES.

1104
00:36:57,338 --> 00:36:59,073
WE WANTED TO FOCUS ON SOME OF

1105
00:36:59,073 --> 00:37:01,075
THE FOUNDATIONAL DETERMINANTS OF

1106
00:37:01,075 --> 00:37:02,944
CARDIOVASCULAR HEALTH WITHIN

1107
00:37:02,944 --> 00:37:04,245
THIS STATEMENT, PARTICULARLY

1108
00:37:04,245 --> 00:37:05,346
WITH THE IMPORTANCE OF STRESS

1109
00:37:05,346 --> 00:37:06,814
AND RESILIENCE, SOCIAL DETERMINE

1110
00:37:06,814 --> 00:37:08,316
NANCE AND STRUCTURAL POLICIES

1111
00:37:08,316 --> 00:37:09,484
THAT ALL NEED TO BE APPROACHED

1112
00:37:09,484 --> 00:37:12,053
IF WE ARE GOING TO OPTIMIZE

1113
00:37:12,053 --> 00:37:13,354
CARDIOVASCULAR HEALTH BROADLY IN

1114
00:37:13,354 --> 00:37:14,556
PREGNANT AND POSTPARTUM

1115
00:37:14,556 --> 00:37:19,360
INDIVIDUALS AND OFFSPRING.

1116
00:37:19,360 --> 00:37:22,897
ONE OF THE THINGS THAT REPEATED

1117
00:37:22,897 --> 00:37:24,332
MEASUREMENTS IN COHORTS IS

1118
00:37:24,332 --> 00:37:25,767
HIGHLIGHTED WITH CARDIOVASCULAR

1119
00:37:25,767 --> 00:37:27,535
HEALTH IS THE YOUNG ADULT PERIOD

1120
00:37:27,535 --> 00:37:29,971
OR THE REPRODUCTIVE YEARS, OFTEN

1121
00:37:29,971 --> 00:37:32,273
SHOW CRITICAL PERIODS OF DECLINE

1122
00:37:32,273 --> 00:37:33,841
IN CARDIOVASCULAR HEALTH.

1123
00:37:33,841 --> 00:37:35,743
SHOWN IN THE FIRST PANEL HERE

1124
00:37:35,743 --> 00:37:37,078
ARE CLINICAL CARDIOVASCULAR

1125
00:37:37,078 --> 00:37:39,013
HEALTH SCORES FROM FIVE

1126
00:37:39,013 --> 00:37:40,815
POPULATION-BASED COHORTS THAT

1127
00:37:40,815 --> 00:37:42,250
IDENTIFIED FIVE DIFFERENT

1128
00:37:42,250 --> 00:37:44,452
TRAJECTORIES SHOWING OVERALL

1129
00:37:44,452 --> 00:37:46,087
DECLINE WITH SOME MORE RAPID

1130
00:37:46,087 --> 00:37:47,989
DECLINE THAN OTHERS, BUT REALLY

1131
00:37:47,989 --> 00:37:49,090
HIGHLIGHTING THIS PERIOD OF TIME

1132
00:37:49,090 --> 00:37:51,059
IN YOUNG ADULTHOOD.

1133
00:37:51,059 --> 00:37:54,295
IN AN OLDER STUDY FROM THE NGHS,

1134
00:37:54,295 --> 00:37:57,065
SHOWN HERE ARE CARDIOVASCULAR

1135
00:37:57,065 --> 00:37:59,534
HEALTH PROFILES FROM OVER 2,000

1136
00:37:59,534 --> 00:38:01,536
INDIVIDUALS AGED 9 TO 19 THAT

1137
00:38:01,536 --> 00:38:03,504
WERE FOLLOWED ANNUALLY FOR THAT

1138
00:38:03,504 --> 00:38:04,839
PERIOD OF TIME, AND AGAIN, WE

1139
00:38:04,839 --> 00:38:08,376
SEE A SIMILAR PATTERN OF VARYING

1140
00:38:08,376 --> 00:38:09,611
CARDIOVASCULAR HEALTH DECLINE,

1141
00:38:09,611 --> 00:38:12,013
WHERE AN INDIVIDUAL STARTED MAY

1142
00:38:12,013 --> 00:38:13,982
INFORM WHERE THEY END UP, BUT

1143
00:38:13,982 --> 00:38:15,450
STILL DIFFERING PATTERNS OVER

1144
00:38:15,450 --> 00:38:16,851
THIS TIME PERIOD.

1145
00:38:16,851 --> 00:38:18,286
ONE OF THE MOST IMPORTANT

1146
00:38:18,286 --> 00:38:23,057
PRETICK TORES AND WHO

1147
00:38:23,057 --> 00:38:24,592
PREDICTORS AND WHO HAD THE MOST

1148
00:38:24,592 --> 00:38:26,494
DECLINE IN TEENAGE GIRLS WAS THE

1149
00:38:26,494 --> 00:38:27,362
INCIDENCE OF PREGNANCY.

1150
00:38:27,362 --> 00:38:28,696
SO THIS WAS REALLY HIGHLIGHTING

1151
00:38:28,696 --> 00:38:30,798
THAT PREGNANCY CAN BE AN

1152
00:38:30,798 --> 00:38:32,667
INFLECTION POINT, UNFORTUNATELY

1153
00:38:32,667 --> 00:38:34,235
FOR WORSENING CARDIOVASCULAR

1154
00:38:34,235 --> 00:38:36,170
HEALTH BUT ALSO IDENTIFIES AN

1155
00:38:36,170 --> 00:38:37,639
OPPORTUNITY FOR TARGETING

1156
00:38:37,639 --> 00:38:39,040
CARDIOVASCULAR HEALTH DURING

1157
00:38:39,040 --> 00:38:42,443
THIS CRITICAL PERIOD.

1158
00:38:42,443 --> 00:38:44,646
BUT GAPS EXIST THAT PREVENT

1159
00:38:44,646 --> 00:38:46,214
IDEAL CARDIOVASCULAR HEALTH FOR

1160
00:38:46,214 --> 00:38:46,981
BIRTHING INDIVIDUALS AND I

1161
00:38:46,981 --> 00:38:48,716
WANTED TO HIGHLIGHT THESE FOUR

1162
00:38:48,716 --> 00:38:49,951
AREAS.

1163
00:38:49,951 --> 00:38:51,519
FIRST, AWARENESS OF

1164
00:38:51,519 --> 00:38:53,288
CARDIOVASCULAR DISEASE RISK BY

1165
00:38:53,288 --> 00:38:54,555
INDIVIDUALS THEMSELVES, AS WELL

1166
00:38:54,555 --> 00:38:55,556
AS CLINICIANS.

1167
00:38:55,556 --> 00:38:58,126
AND FOLLOWING THAT, AWARENESS OF

1168
00:38:58,126 --> 00:38:59,894
ADVERSE PREGNANCY OUTCOMES AS

1169
00:38:59,894 --> 00:39:01,095
CARDIOVASCULAR DISEASE RISK

1170
00:39:01,095 --> 00:39:02,063
ENHANCERS.

1171
00:39:02,063 --> 00:39:04,666
IN ORDER TO BETTER ESTIMATE

1172
00:39:04,666 --> 00:39:08,036
RISK, ENSURING THAT

1173
00:39:08,036 --> 00:39:10,204
CARDIOVASCULAR RISK PREDICTION

1174
00:39:10,204 --> 00:39:11,506
TOOLS ARE AVAILABLE FOR ADULTS

1175
00:39:11,506 --> 00:39:14,008
AND ENSURING WE DO THIS IN THE

1176
00:39:14,008 --> 00:39:15,209
CONTEXT OF SOCIAL AND STRUCTURAL

1177
00:39:15,209 --> 00:39:16,177
FACTORS SUCH AS SOCIAL

1178
00:39:16,177 --> 00:39:19,080
DETERMINANTS OF HEALTH.

1179
00:39:19,080 --> 00:39:20,515
MANY OF YOU ARE PROBABLY

1180
00:39:20,515 --> 00:39:21,816
FAMILIAR WITH THESE DATA THAT

1181
00:39:21,816 --> 00:39:23,284
ARE HIGHLIGHTED FROM THE

1182
00:39:23,284 --> 00:39:26,254
AMERICAN HEART ASSOCIATION THAT

1183
00:39:26,254 --> 00:39:27,989
DEMONSTRATED THAT THERE IS AN

1184
00:39:27,989 --> 00:39:29,190
UNDERAPPRECIATION OR

1185
00:39:29,190 --> 00:39:30,458
UNDERAWARENESS BY INDIVIDUALS

1186
00:39:30,458 --> 00:39:32,460
FOR THE LEADING CAUSE OF DEATH

1187
00:39:32,460 --> 00:39:39,233
AMONG WOMEN -- HEART DISEASE.

1188
00:39:39,233 --> 00:39:40,335
REPORTED THAT HEART DISEASE WAS

1189
00:39:40,335 --> 00:39:41,402
THEIR LEADING CAUSE OF DEATH,

1190
00:39:41,402 --> 00:39:44,706
THIS DROPPED TO BELOW 50%.

1191
00:39:44,706 --> 00:39:47,475
IN A SURVEY LED AT OUR CENTER,

1192
00:39:47,475 --> 00:39:49,410
WE SURVEYED 700 POSTPARTUM

1193
00:39:49,410 --> 00:39:52,347
PEOPLE AND ONLY ABOUT 50% OF

1194
00:39:52,347 --> 00:39:53,548
INDIVIDUALS WHO HAD EXPERIENCED

1195
00:39:53,548 --> 00:39:55,116
AN ADVERSE PREGNANCY OUTCOME

1196
00:39:55,116 --> 00:39:56,584
RECOGNIZED THAT THEIR

1197
00:39:56,584 --> 00:39:58,319
CARDIOVASCULAR DISEASE RISK WAS

1198
00:39:58,319 --> 00:39:59,187
HIGHER THAN AVERAGE.

1199
00:39:59,187 --> 00:40:00,988
AND WE'VE SEEN SIMILAR STUDIES

1200
00:40:00,988 --> 00:40:03,491
FROM OTHER CENTERS AS WELL AS

1201
00:40:03,491 --> 00:40:06,027
FROM A CLINICAL PER EXECUTIVE OF

1202
00:40:06,027 --> 00:40:07,028
CLINICIANS NOT BEING AWARE OF

1203
00:40:07,028 --> 00:40:10,665
THIS RISK AS WELL.

1204
00:40:10,665 --> 00:40:12,834
WE ALSO KNOW THAT THERE ARE GAPS

1205
00:40:12,834 --> 00:40:13,835
IN CARDIOVASCULAR DISEASE

1206
00:40:13,835 --> 00:40:15,403
GUIDELINES AFTER AN ADVERSE

1207
00:40:15,403 --> 00:40:16,070
PREGNANCY OUTCOME.

1208
00:40:16,070 --> 00:40:17,739
WHILE THE 2019 PRIMARY

1209
00:40:17,739 --> 00:40:19,140
PREVENTION GUIDELINES RECOMMEND

1210
00:40:19,140 --> 00:40:21,576
RISK ASSESSMENT WITH THE POOLED

1211
00:40:21,576 --> 00:40:23,010
COHORT EQUATIONS AND HIGHLIGHT

1212
00:40:23,010 --> 00:40:24,212
ADVERSE PREGNANCY OUTCOMES AS

1213
00:40:24,212 --> 00:40:25,446
RISK ENHANCING FACTORS, THERE

1214
00:40:25,446 --> 00:40:26,948
ARE NO SPECIFIC RECOMMENDATIONS

1215
00:40:26,948 --> 00:40:28,816
FOR THOSE WHO EXPERIENCE AN

1216
00:40:28,816 --> 00:40:32,687
ADVERSE PREGNANCY OUT COME.

1217
00:40:32,687 --> 00:40:34,355
IN FACT, CURRENT RECOMMENDATIONS

1218
00:40:34,355 --> 00:40:37,592
FOR YOUNG ADULTS ALSO FOCUS ON

1219
00:40:37,592 --> 00:40:39,794
RISK ASSESSMENT WITH 30-YEAR

1220
00:40:39,794 --> 00:40:43,164
RISK BUT THE POOLED COHORT

1221
00:40:43,164 --> 00:40:45,433
EQUATIONS BEGIN AT AGE 40.

1222
00:40:45,433 --> 00:40:47,402
ONE WAY WE WERE ABLE TO RECENTLY

1223
00:40:47,402 --> 00:40:48,903
ADDRESS THIS WAS WITH A

1224
00:40:48,903 --> 00:40:51,072
DEVELOPMENT AND VALIDATION OF

1225
00:40:51,072 --> 00:40:53,241
THE 2023 PREDICTING RISK IN

1226
00:40:53,241 --> 00:40:54,342
CARDIOVASCULAR DISEASE EQUATIONS

1227
00:40:54,342 --> 00:40:56,043
OR THE PREVENT EQUATIONS WHICH

1228
00:40:56,043 --> 00:40:58,913
NOW ENABLE RISK CALCULATION AT

1229
00:40:58,913 --> 00:41:01,182
AGE 30 AND INCLUDE 10-YEAR AND

1230
00:41:01,182 --> 00:41:06,421
30-YEAR RISK ESTIMATION.

1231
00:41:06,421 --> 00:41:08,790
AS WE SAID PORPLY, ASSESSING AND

1232
00:41:08,790 --> 00:41:09,557
ADDRESSING SOCIAL DETERMINANTS

1233
00:41:09,557 --> 00:41:10,658
OF HEALTH WHICH ARE THE

1234
00:41:10,658 --> 00:41:12,059
FUNDAMENTAL CAUSES OF HEALTH

1235
00:41:12,059 --> 00:41:14,328
INEQUITY ARE NEEDED.

1236
00:41:14,328 --> 00:41:18,699
AND A VERY, I THINK, POINTED

1237
00:41:18,699 --> 00:41:20,601
QUOTE FROM KAREN JOINT MADDOX

1238
00:41:20,601 --> 00:41:22,069
I'VE HEARD BEFORE WHICH I THINK

1239
00:41:22,069 --> 00:41:23,471
IS HIGHLY RELEVANT HERE IS THAT

1240
00:41:23,471 --> 00:41:24,572
STRUCTURAL PROBLEMS REQUIRE

1241
00:41:24,572 --> 00:41:25,606
STRUCTURAL SOLUTIONS, SO BEING

1242
00:41:25,606 --> 00:41:27,508
ABLE TO FOCUS ON THIS AS WE MOVE

1243
00:41:27,508 --> 00:41:32,313
FORWARD IS CRITICAL.

1244
00:41:32,313 --> 00:41:34,215
SO WHAT ABOUT QUESTIONS THAT ARE

1245
00:41:34,215 --> 00:41:34,515
UNANSWERED?

1246
00:41:34,515 --> 00:41:36,217
AND HOW DO WE FILL THESE GAPS

1247
00:41:36,217 --> 00:41:36,751
THAT EXIST?

1248
00:41:36,751 --> 00:41:39,220
AND IF WE FOCUS ON MEASURING AND

1249
00:41:39,220 --> 00:41:40,655
MODIFYING CARDIOVASCULAR HEALTH,

1250
00:41:40,655 --> 00:41:42,690
I'M GOING TO CONCLUDE WITH FOUR

1251
00:41:42,690 --> 00:41:43,958
KEY QUESTIONS.

1252
00:41:43,958 --> 00:41:45,893
HOW SHOULD WE MONITOR AND TREAT

1253
00:41:45,893 --> 00:41:47,495
BLOOD PRESSURE AS A KEY TARGET

1254
00:41:47,495 --> 00:41:49,230
IN THE POSTPARTUM PERIOD?

1255
00:41:49,230 --> 00:41:51,999
WHAT ARE THE PATHWAYS,

1256
00:41:51,999 --> 00:41:53,568
PREDICTORS AND MEDIATORS TO

1257
00:41:53,568 --> 00:41:54,435
CLINICAL CARDIOVASCULAR DISEASE?

1258
00:41:54,435 --> 00:41:56,404
HOW DO WE INTEGRATE THE NEW

1259
00:41:56,404 --> 00:41:58,539
CONSTRUCT OF CARDIOVASCULAR

1260
00:41:58,539 --> 00:41:59,674
KIDNEY METABOLIC HEALTH THAT THE

1261
00:41:59,674 --> 00:42:01,142
AMERICAN HEART ASSOCIATION

1262
00:42:01,142 --> 00:42:02,643
RECENTLY RELEASED THAT BUILDS ON

1263
00:42:02,643 --> 00:42:04,779
THE CONCEPT OF LIFE'S ESSENTIAL

1264
00:42:04,779 --> 00:42:06,581
EIGHT AND CARDIOVASCULAR HEALTH,

1265
00:42:06,581 --> 00:42:08,883
AND LOW DO WE DESIGN MULTILEVEL

1266
00:42:08,883 --> 00:42:10,551
INTERVENTIONS FOR CARDIOVASCULAR

1267
00:42:10,551 --> 00:42:12,753
HEALTH EQUITY.

1268
00:42:12,753 --> 00:42:14,856
IN TERMS OF WHEN AND HOW TO

1269
00:42:14,856 --> 00:42:16,123
TREAT BLOOD PRESSURE POSTPARTUM,

1270
00:42:16,123 --> 00:42:18,493
THERE ARE LIMITED DATA IN BLOOD

1271
00:42:18,493 --> 00:42:19,927
PRESSURE DURING PREGNANCY AND

1272
00:42:19,927 --> 00:42:21,562
POSTPARTUM THAT HAVE FOLLOWED

1273
00:42:21,562 --> 00:42:23,197
INDIVIDUALS THROUGHOUT THESE TWO

1274
00:42:23,197 --> 00:42:23,764
TIME PERIODS.

1275
00:42:23,764 --> 00:42:26,467
AND THIS IS SOME DATA THAT SHOW

1276
00:42:26,467 --> 00:42:27,768
THAT INDIVIDUALS WHO HAVE A

1277
00:42:27,768 --> 00:42:28,870
HYPERTENSIVE DISORDER OF

1278
00:42:28,870 --> 00:42:30,471
PREGNANCY MAY FOLLOW TWO

1279
00:42:30,471 --> 00:42:31,672
DIFFERENT TRAJECTORIES.

1280
00:42:31,672 --> 00:42:33,174
SOME REMAIN ELEVATED AND SOME

1281
00:42:33,174 --> 00:42:34,242
RETURN BACK TO NORMAL.

1282
00:42:34,242 --> 00:42:36,878
BUT HOW DO WE KNOW WHO ENDS IN

1283
00:42:36,878 --> 00:42:38,279
WHICH GROUP AND HOW TO TREAT

1284
00:42:38,279 --> 00:42:41,883
THEM BEST?

1285
00:42:41,883 --> 00:42:46,721
IN AN R34 FUNDED BY NHLBI, THIS

1286
00:42:46,721 --> 00:42:49,290
QUESTION IS BEING STUDIED IN A

1287
00:42:49,290 --> 00:42:50,925
PILOT STUDY TO LOOK AT MORE

1288
00:42:50,925 --> 00:42:52,493
INTENSIVE AND LESS INTENSIVE

1289
00:42:52,493 --> 00:42:56,030
BLOOD PRESSURE CONTROL IN EARLY

1290
00:42:56,030 --> 00:42:56,330
POSTPARTUM.

1291
00:42:56,330 --> 00:42:57,331
AND STARTING TO ADDRESS THIS

1292
00:42:57,331 --> 00:42:59,200
QUESTION OF WHAT ARE THE OPTIMAL

1293
00:42:59,200 --> 00:43:00,434
BLOOD PRESSURE GOALS AFTER

1294
00:43:00,434 --> 00:43:01,969
HYPERTENSIVE DISORDERS IN THE

1295
00:43:01,969 --> 00:43:03,504
POSTPARTUM PERIOD, AND HOW EARLY

1296
00:43:03,504 --> 00:43:06,908
SHOULD INTERVENTIONS BEGIN?

1297
00:43:06,908 --> 00:43:08,409
I THINK AS WE THINK ABOUT THESE

1298
00:43:08,409 --> 00:43:09,310
QUESTIONS, OTHER RELATED

1299
00:43:09,310 --> 00:43:12,146
QUESTIONS THAT WE NEED TO BETTER

1300
00:43:12,146 --> 00:43:13,214
UNDERSTAND INCLUDE HOW DO WE

1301
00:43:13,214 --> 00:43:15,149
SUPPORT AND SUPPLEMENT

1302
00:43:15,149 --> 00:43:17,351
ANTIHYPERTENSIVE THERAPY WITH

1303
00:43:17,351 --> 00:43:17,985
LIFESTYLE, BEHAVIORAL

1304
00:43:17,985 --> 00:43:20,288
INTERVENTIONS IN THIS PERIOD?

1305
00:43:20,288 --> 00:43:21,556
SHOULD ASPIRIN OR STATINS BE

1306
00:43:21,556 --> 00:43:22,757
USED IN THIS PERIOD?

1307
00:43:22,757 --> 00:43:25,059
OR IN THE SHORT TERM AFTER A

1308
00:43:25,059 --> 00:43:25,826
HYPERTENSIVE DISORDER OF

1309
00:43:25,826 --> 00:43:27,995
PREGNANCY?

1310
00:43:27,995 --> 00:43:29,263
AND SHOULD WE TARGET

1311
00:43:29,263 --> 00:43:30,131
INTERVENTIONS EVEN AMONG THOSE

1312
00:43:30,131 --> 00:43:32,333
WHO DON'T EXPERIENCE A

1313
00:43:32,333 --> 00:43:33,601
HYPERTENSIVE DISORDER BUT HAVE

1314
00:43:33,601 --> 00:43:37,772
ELEVATED BLOOD PRESSURE ALONE?

1315
00:43:37,772 --> 00:43:39,307
SECOND IS HOW DO WE DEFINE THE

1316
00:43:39,307 --> 00:43:41,676
PATHWAYS AND MECHANISMS IN THE

1317
00:43:41,676 --> 00:43:42,343
PERIPARTUM PERIOD?

1318
00:43:42,343 --> 00:43:44,312
WE KNOW THAT CLINICAL

1319
00:43:44,312 --> 00:43:45,379
CARDIOVASCULAR DISEASE OFTEN

1320
00:43:45,379 --> 00:43:47,315
OCCURS IN THE SIXTH DECADE OF

1321
00:43:47,315 --> 00:43:49,083
LIFE BUT THE ORIGINS OF DISEASE

1322
00:43:49,083 --> 00:43:51,686
BEGIN MUCH EARLIER.

1323
00:43:51,686 --> 00:43:53,521
AUTOPSY STUDIES HIGHLIGHT BY THE

1324
00:43:53,521 --> 00:43:55,289
SECOND DECADE OF LIKE, THERE ARE

1325
00:43:55,289 --> 00:43:58,125
PLAQUES ALREADY DEVELOPING AND

1326
00:43:58,125 --> 00:43:59,994
PROGRESSING EVEN AS EARLY AS AGE

1327
00:43:59,994 --> 00:44:02,129
20s AND 30s WHEN PEOPLE MAY

1328
00:44:02,129 --> 00:44:03,664
BE BECOMING PREGNANT.

1329
00:44:03,664 --> 00:44:05,733
SO SUBCLINICAL MEASURES OF

1330
00:44:05,733 --> 00:44:06,867
CARDIOVASCULAR DISEASE WITH

1331
00:44:06,867 --> 00:44:07,602
ULTRASOUND SPECIFICALLY CAN BE

1332
00:44:07,602 --> 00:44:11,405
VERY USEFUL, AND IN THIS

1333
00:44:11,405 --> 00:44:14,075
R01 FUNDED BY NHLBI, WHICH IS

1334
00:44:14,075 --> 00:44:15,409
ANCILLARY TO THE NEW MOM TO BE

1335
00:44:15,409 --> 00:44:17,378
HEART HEALTH STUDY, WE'RE

1336
00:44:17,378 --> 00:44:19,113
CURRENTLY DOING CAROTID

1337
00:44:19,113 --> 00:44:22,683
ULTRASOUND TO LOOK AT VASCULAR

1338
00:44:22,683 --> 00:44:24,552
INJURY AS WELL AS THICKNESS TO

1339
00:44:24,552 --> 00:44:25,753
BETTER UNDERSTAND THE PATHWAYS

1340
00:44:25,753 --> 00:44:27,388
FROM EARLY PREG SEAL WHEN THESE

1341
00:44:27,388 --> 00:44:29,824
INDIVIDUALS WERE FIRST RECRUITED

1342
00:44:29,824 --> 00:44:33,894
TO RIGOROUS ADJUDICATION OF

1343
00:44:33,894 --> 00:44:36,631
PREGNANCY OUTCOMES AND FOLLOW-UP

1344
00:44:36,631 --> 00:44:38,532
MEASURES ABOUT 10 YEARS DO DOWNE

1345
00:44:38,532 --> 00:44:41,602
ROAD.

1346
00:44:41,602 --> 00:44:43,371
THIRD, THIS QUESTION OF HOW DO

1347
00:44:43,371 --> 00:44:45,339
WE BROADEN AND THINK ABOUT MORE

1348
00:44:45,339 --> 00:44:47,041
INCLUSIVELY KIDNEY HEALTH,

1349
00:44:47,041 --> 00:44:48,242
METABOLIC HEALTH AND

1350
00:44:48,242 --> 00:44:49,577
CARDIOVASCULAR DISEASE RISK FOR

1351
00:44:49,577 --> 00:44:51,979
THE PREGNANT AND POSTPARTUM

1352
00:44:51,979 --> 00:44:52,413
INDIVIDUAL?

1353
00:44:52,413 --> 00:44:55,082
LAST YEAR THE AHA RELEASED THIS

1354
00:44:55,082 --> 00:44:56,050
PRESIDENTIAL ADVISORY WHICH I

1355
00:44:56,050 --> 00:44:57,351
WAS FORTUNATE TO WORK WITH THIS

1356
00:44:57,351 --> 00:44:59,654
AMAZING TEAM ON DEFINING

1357
00:44:59,654 --> 00:45:01,155
CARDIOVASCULAR KIDNEY METABOLIC

1358
00:45:01,155 --> 00:45:02,356
SYNDROME AS A HEALTH DISORDER

1359
00:45:02,356 --> 00:45:04,191
DUE TO CONNECTIONS AMONG HEART

1360
00:45:04,191 --> 00:45:05,693
DISEASE, KIDNEY DISEASE,

1361
00:45:05,693 --> 00:45:08,229
DIABETES AND OBESITY LEADING TO

1362
00:45:08,229 --> 00:45:09,864
POOR HEALTH OUTCOMES, NOTINGLY

1363
00:45:09,864 --> 00:45:11,799
WE INCLUDED GESTATIONAL DIABETES

1364
00:45:11,799 --> 00:45:12,900
AND HYPERTENSIVE DISORDERS OF

1365
00:45:12,900 --> 00:45:14,068
PREGNANCY WITHIN THE FRAMEWORK,

1366
00:45:14,068 --> 00:45:15,469
BUT I THINK ONE THING THAT WE

1367
00:45:15,469 --> 00:45:16,837
REALLY NEED TO BUILD ON AS WE

1368
00:45:16,837 --> 00:45:19,106
THINK ABOUT THE PERIPARTUM

1369
00:45:19,106 --> 00:45:21,842
PERIOD IS HOW DO WE INTEGRATE

1370
00:45:21,842 --> 00:45:23,244
THE STAGING INTO THIS POPULATION

1371
00:45:23,244 --> 00:45:27,281
FOR DELIVERY OF CARE.

1372
00:45:27,281 --> 00:45:29,450
LAST, HOW DO WE THINK ABOUT THE

1373
00:45:29,450 --> 00:45:31,485
WHOLE PICTURE WITHIN A

1374
00:45:31,485 --> 00:45:32,586
SOCIOECOLOGICAL FRAMEWORK THAT

1375
00:45:32,586 --> 00:45:34,789
LOOKS AT POLICIES, COMMUNITY

1376
00:45:34,789 --> 00:45:36,323
ENGAGED INTERVENTIONS, HEALTH

1377
00:45:36,323 --> 00:45:37,625
SYSTEM BASED INTERVENTIONS AS

1378
00:45:37,625 --> 00:45:39,694
WELL AS THE INDIVIDUAL PATIENT

1379
00:45:39,694 --> 00:45:40,027
CLINICIAN.

1380
00:45:40,027 --> 00:45:41,462
SHOWN HERE ARE SOME EXAMPLES OF

1381
00:45:41,462 --> 00:45:43,230
POLICIES THAT COULD BE

1382
00:45:43,230 --> 00:45:44,165
CONSIDERED AND ARE CURRENTLY

1383
00:45:44,165 --> 00:45:45,766
BEING CONSIDERED INCLUDING

1384
00:45:45,766 --> 00:45:47,268
POSTPARTUM MEDICAID EXTENSION

1385
00:45:47,268 --> 00:45:49,236
AND SMOKING BANS, THINKING ABOUT

1386
00:45:49,236 --> 00:45:51,505
COMMUNITY ENGAGED INTERVENTIONS,

1387
00:45:51,505 --> 00:45:52,940
TARGETING CHURCH-BASED

1388
00:45:52,940 --> 00:45:54,675
INTERVENTIONS AND BARBERSHOP

1389
00:45:54,675 --> 00:45:55,776
INTERVENTIONS FOR LOWERING BLOOD

1390
00:45:55,776 --> 00:45:56,744
PRESSURE, HEALTH SYSTEM

1391
00:45:56,744 --> 00:46:01,782
INTERVENTIONS LIKE REMOTE PLOOPD

1392
00:46:01,782 --> 00:46:06,287
PRESSURE MONITORING AND AT THE

1393
00:46:06,287 --> 00:46:07,388
INDIVIDUAL CLINICIAN-PATIENT

1394
00:46:07,388 --> 00:46:07,588
LEVEL.

1395
00:46:07,588 --> 00:46:09,156
ONE OF THE PROJECTS THAT I AM

1396
00:46:09,156 --> 00:46:12,259
REALLY EXCITED TO BE WORKING ON

1397
00:46:12,259 --> 00:46:14,795
WITH DR. CHARLOTTE PRATT FROM

1398
00:46:14,795 --> 00:46:16,097
NHLBI AS WELL AS DR. PRICE AND

1399
00:46:16,097 --> 00:46:17,598
DR. DONZE AND MANY OTHERS IS THE

1400
00:46:17,598 --> 00:46:19,033
ENRICH STUDY, THE EARLY

1401
00:46:19,033 --> 00:46:20,234
INTERVENTION TO PROMOTE

1402
00:46:20,234 --> 00:46:21,435
CARDIOVASCULAR HEALTH OF MOTHERS

1403
00:46:21,435 --> 00:46:22,803
AND CHILDREN.

1404
00:46:22,803 --> 00:46:23,804
SHOWN HERE ARE THE SITES THAT

1405
00:46:23,804 --> 00:46:26,207
ARE INVOLVED IN THE ENRICH

1406
00:46:26,207 --> 00:46:28,509
PROJECT, AND IF WE GO BACK A

1407
00:46:28,509 --> 00:46:29,910
SLIDE, JUST HIGHLIGHTING SOME OF

1408
00:46:29,910 --> 00:46:32,513
THE KEY INNOVATIONS OF ENRICH

1409
00:46:32,513 --> 00:46:35,583
INCLUDE THE APPROACH USING

1410
00:46:35,583 --> 00:46:36,584
EVIDENCE-BASED -- TO LEVERAGE

1411
00:46:36,584 --> 00:46:38,119
EXISTING SETTINGS WHERE FAMILIES

1412
00:46:38,119 --> 00:46:40,621
WHO HAVE ADVERSE SOCIAL FACTORS

1413
00:46:40,621 --> 00:46:42,623
ARE ALREADY RECEIVING CARE TO

1414
00:46:42,623 --> 00:46:44,325
ALLOW A SCALABLE APPROACH WITH A

1415
00:46:44,325 --> 00:46:46,627
FOCUS ON HEALTH EQUITY.

1416
00:46:46,627 --> 00:46:48,896
THE ENRICH STUDIES ALSO FOCUSING

1417
00:46:48,896 --> 00:46:50,331
ON TWO GENERATIONS, BOTH PARENT

1418
00:46:50,331 --> 00:46:54,168
AND CHILD, THAT UNIQUELY WILL

1419
00:46:54,168 --> 00:46:55,703
EXAMINE AN INTERVENTION AND

1420
00:46:55,703 --> 00:46:58,205
MEASURE CVH IN A REMOTE

1421
00:46:58,205 --> 00:47:01,375
DECENTRALIZED TRIAL DESIGN.

1422
00:47:01,375 --> 00:47:02,810
SO I WANT TO SUMMARIZE WHAT

1423
00:47:02,810 --> 00:47:04,345
WE'VE TALKED ABOUT WITH THREE

1424
00:47:04,345 --> 00:47:07,948
KEY TAKEAWAYS.

1425
00:47:07,948 --> 00:47:10,651
THE REPRODUCTIVE LIFE COURSE

1426
00:47:10,651 --> 00:47:11,852
FRAMEWORK OR THAT CONCEPTUAL

1427
00:47:11,852 --> 00:47:13,621
FIGURE WE USE HIGHLIGHTS THE

1428
00:47:13,621 --> 00:47:15,022
PERIPARTUM PERIOD AS A WINDOW OF

1429
00:47:15,022 --> 00:47:17,224
OPPORTUNITY WHEN RISK FOR

1430
00:47:17,224 --> 00:47:19,226
CARDIOVASCULAR DISEASE IS

1431
00:47:19,226 --> 00:47:19,727
UNMASKED.

1432
00:47:19,727 --> 00:47:21,028
SECOND, WE LOOKED AT SECULAR

1433
00:47:21,028 --> 00:47:22,797
TRENDS SHOWING POPULATION LEVEL

1434
00:47:22,797 --> 00:47:24,198
DECLINES IN OPTIMAL

1435
00:47:24,198 --> 00:47:25,299
CARDIOVASCULAR HEALTH AS REALLY

1436
00:47:25,299 --> 00:47:28,235
THE MAJOR DRIVER OF ADVERSE

1437
00:47:28,235 --> 00:47:29,637
TRENDS AND ADVERSE PREGNANCY

1438
00:47:29,637 --> 00:47:30,971
OUTCOMES EVEN IN YOUNGER

1439
00:47:30,971 --> 00:47:33,040
GENERATIONS AND PARTICULARLY IN

1440
00:47:33,040 --> 00:47:34,875
YOUNGER GENERATIONS WITH

1441
00:47:34,875 --> 00:47:36,076
PERSISTENT RACIAL AND ETHNIC

1442
00:47:36,076 --> 00:47:36,510
DISPARITIES.

1443
00:47:36,510 --> 00:47:39,046
AND THIRD, A SHIFT TOWARDS

1444
00:47:39,046 --> 00:47:40,748
GENERATING AND IMPLENTYING

1445
00:47:40,748 --> 00:47:42,716
EVIDENCE BASE TO MEASURE, MODIFY

1446
00:47:42,716 --> 00:47:44,919
AND MONITOR CVH AND PERHAPS NOW

1447
00:47:44,919 --> 00:47:47,288
MORE BROADLY CARDIOVASCULAR

1448
00:47:47,288 --> 00:47:47,955
KIDNEY METABOLIC HEALTH IS

1449
00:47:47,955 --> 00:47:51,892
NEEDED TO ACHIEVE HEALTH EQUITY.

1450
00:47:51,892 --> 00:47:54,161
SO I'M GOING TO END WITH THE

1451
00:47:54,161 --> 00:47:55,462
ANALOGY THAT WE STARTED WITH IN

1452
00:47:55,462 --> 00:47:57,331
TERMS OF PREGNANCY AS A WINDOW

1453
00:47:57,331 --> 00:47:59,700
TO FUTURE CARDIOVASCULAR HEALTH

1454
00:47:59,700 --> 00:48:01,502
AND PROPOSE THAT WE THINK ABOUT

1455
00:48:01,502 --> 00:48:03,871
THE FULL PERIPARTUM SPECTRUM AS

1456
00:48:03,871 --> 00:48:05,206
OUR IDEAL WINDOWS OF OPPORTUNITY

1457
00:48:05,206 --> 00:48:07,474
TO IMPROVE CARDIOVASCULAR HEALTH

1458
00:48:07,474 --> 00:48:09,243
AND CARDIOVASCULAR KIDNEY

1459
00:48:09,243 --> 00:48:15,282
METABOLIC HEALTH.

1460
00:48:15,282 --> 00:48:15,549
WONDERFUL.

1461
00:48:15,549 --> 00:48:17,451
THANK YOU SO MUCH FOR YOUR TIME

1462
00:48:17,451 --> 00:48:19,019
AND ATTENTION, AND LOOK FORWARD

1463
00:48:19,019 --> 00:48:26,260
TO THE DISCUSSION AND Q & A.

1464
00:48:26,260 --> 00:48:26,961
>> WONDERFUL.

1465
00:48:26,961 --> 00:48:28,529
THANK YOU, DR. KHAN, FOR YOUR

1466
00:48:28,529 --> 00:48:30,798
EXCELLENT PRESENTATION.

1467
00:48:30,798 --> 00:48:33,634
THIS IS A VERY TIMELY TOPIC

1468
00:48:33,634 --> 00:48:36,370
ESPECIALLY IN WITH THE INCREASE

1469
00:48:36,370 --> 00:48:37,671
OF ADVERSE PREGNANCIES IN RECENT

1470
00:48:37,671 --> 00:48:38,873
YEARS SO I'M VERY EXCITE TODAY

1471
00:48:38,873 --> 00:48:39,406
HAVE THIS DISCUSSION.

1472
00:48:39,406 --> 00:48:40,608
I WOULD LIKE TO REMIND THE

1473
00:48:40,608 --> 00:48:43,577
AUDIENCE TO PLEASE EMAIL YOUR

1474
00:48:43,577 --> 00:48:47,514
QUESTIONS TO ONPA@MAIL.NIH.GOV,

1475
00:48:47,514 --> 00:48:48,916
OR YOU CAN SUBMIT THEM THROUGH

1476
00:48:48,916 --> 00:48:52,820
THE LIVE FEEDBACK IN THE

1477
00:48:52,820 --> 00:48:54,154
VIDEOCAST.

1478
00:48:54,154 --> 00:48:55,689
AS THE QUESTIONS ARE COMING IN,

1479
00:48:55,689 --> 00:48:58,092
DR. KHAN, I WOULD LIKE TO

1480
00:48:58,092 --> 00:48:59,093
PROPOSE -- OR POSE ONE QUESTION

1481
00:48:59,093 --> 00:48:59,860
TO YOU.

1482
00:48:59,860 --> 00:49:03,797
SO FIRST I REALLY LOVE THAT YOU

1483
00:49:03,797 --> 00:49:05,165
DISCUSSED THE -- OR AT LEAST

1484
00:49:05,165 --> 00:49:07,768
MENTIONED THE MENOPAUSAL AND

1485
00:49:07,768 --> 00:49:08,769
POST-MENOPAUSAL PERIODS AS A

1486
00:49:08,769 --> 00:49:10,838
PART OF THE POSTPARTUM PHASE OF

1487
00:49:10,838 --> 00:49:11,438
A WOMAN'S LIFE.

1488
00:49:11,438 --> 00:49:12,840
I THINK WE OFTEN DON'T THINK

1489
00:49:12,840 --> 00:49:14,174
ABOUT THAT.

1490
00:49:14,174 --> 00:49:16,610
TYPICALLY AS YOU SAID, WE OFTEN

1491
00:49:16,610 --> 00:49:18,212
CONSIDER JUST THAT UP TO THE ONE

1492
00:49:18,212 --> 00:49:20,781
YEAR, RIGHT, POST BIRTH.

1493
00:49:20,781 --> 00:49:23,083
SO DO YOU KNOW IF THERE ARE ANY

1494
00:49:23,083 --> 00:49:25,986
STUDIES THAT HAVE BEEN PUBLISHED

1495
00:49:25,986 --> 00:49:27,621
LINKING PERINATAL HEALTH TO

1496
00:49:27,621 --> 00:49:28,489
CARDIOVASCULAR HEALTH, EITHER

1497
00:49:28,489 --> 00:49:32,259
DURING THE MENOPAUSAL TRANSITION

1498
00:49:32,259 --> 00:49:33,193
OR POST-MENOPAUSAL PERIODS?

1499
00:49:33,193 --> 00:49:35,496
>> IT'S A REALLY GREAT
QUESTION,

1500
00:49:35,496 --> 00:49:37,765
AND I THINK IT HELPS TO

1501
00:49:37,765 --> 00:49:38,432
CONCEPTUALIZE THAT FULL LIFE

1502
00:49:38,432 --> 00:49:39,733
COURSE APPROACH, WHERE WE'RE

1503
00:49:39,733 --> 00:49:41,502
THINKING ABOUT PREGNANCY AND

1504
00:49:41,502 --> 00:49:43,370
MENOPAUSE AS BOTH BEING REALLY

1505
00:49:43,370 --> 00:49:46,473
KEY LIFE EVENTS IN A

1506
00:49:46,473 --> 00:49:47,107
PREGNANCY-CAPABLE INDIVIDUAL

1507
00:49:47,107 --> 00:49:48,108
WHEN SIGNIFICANT METABOLIC

1508
00:49:48,108 --> 00:49:48,976
CHANGES ARE HAPPENING.

1509
00:49:48,976 --> 00:49:50,778
I THINK BOTH OF THOSE

1510
00:49:50,778 --> 00:49:53,714
TRANSITIONS ARE OFTEN KIND OF

1511
00:49:53,714 --> 00:49:56,250
ASSOCIATED WITH ADVERSE CHANGES

1512
00:49:56,250 --> 00:49:57,818
IN CARDIOMETABOLIC FACTORS, BUT

1513
00:49:57,818 --> 00:49:58,686
IT'S STILL UNCLEAR WHETHER OR

1514
00:49:58,686 --> 00:50:00,387
NOT THOSE ARE MARKERS OR

1515
00:50:00,387 --> 00:50:01,588
MEDIATORS OF THOSE CHANGES THAT

1516
00:50:01,588 --> 00:50:02,990
ARE OCCURRING THEN.

1517
00:50:02,990 --> 00:50:05,793
IN TERMS OF THE LINK BETWEEN

1518
00:50:05,793 --> 00:50:08,095
ADVERSE PREGNANCY OUTCOMES AND

1519
00:50:08,095 --> 00:50:09,496
MENOPAUSAL HEALTH OR

1520
00:50:09,496 --> 00:50:10,531
CARDIOMETABOLIC HEALTH OR

1521
00:50:10,531 --> 00:50:12,066
CHANGES DURING MENOPAUSE, I

1522
00:50:12,066 --> 00:50:13,834
THINK THE BEST STUDY THAT

1523
00:50:13,834 --> 00:50:17,972
PROBABLY HAS TRACKED THEM MAY BE

1524
00:50:17,972 --> 00:50:19,139
RETROSPECTIVE DATA FROM THE SWAN

1525
00:50:19,139 --> 00:50:20,441
STUDY LOOKING AT INDIVIDUALS WHO

1526
00:50:20,441 --> 00:50:22,076
HAVE HYPERTENSIVE DISORDERS OF

1527
00:50:22,076 --> 00:50:24,244
PREGNANCY, HAVING WORSE

1528
00:50:24,244 --> 00:50:25,512
CARDIOMETABOLIC HEALTH AROUND

1529
00:50:25,512 --> 00:50:26,480
THE PERIMENOPAUSAL TRANSITION,

1530
00:50:26,480 --> 00:50:29,249
BUT I DO THINK THE NEW MOM TO BE

1531
00:50:29,249 --> 00:50:31,151
HEART HEALTH STUDY, NOT JUST

1532
00:50:31,151 --> 00:50:32,353
BIASED BECAUSE I WORK WITH THEM,

1533
00:50:32,353 --> 00:50:34,989
IS REALLY VERY WELL POSITIONED

1534
00:50:34,989 --> 00:50:37,024
RIGHT NOW AS MANY OF THOSE

1535
00:50:37,024 --> 00:50:38,325
INDIVIDUALS ARE ABOUT TO

1536
00:50:38,325 --> 00:50:41,161
TRANSITION AND GO THROUGH THAT

1537
00:50:41,161 --> 00:50:42,629
PERIMENOPAUSAL PERIOD, HAVING

1538
00:50:42,629 --> 00:50:44,732
HAD FOLLOW-UP FROM THEIR FIRST

1539
00:50:44,732 --> 00:50:46,033
PREGNANCY SO BEING ABLE TO

1540
00:50:46,033 --> 00:50:48,569
REALLY START THEM AT A

1541
00:50:48,569 --> 00:50:49,903
MEASUREMENT OF CARDIOVASCULAR

1542
00:50:49,903 --> 00:50:51,905
HEALTH AT THAT FIRST PERIOD WITH

1543
00:50:51,905 --> 00:50:53,741
RIGOROUS ADJUDICATION OF ADVERSE

1544
00:50:53,741 --> 00:50:55,075
PREGNANCY OUTCOME STATUS AND NOW

1545
00:50:55,075 --> 00:50:56,243
COMING INTO THAT TRANSITION.

1546
00:50:56,243 --> 00:50:58,212
SO I THINK THAT COHORT IS REALLY

1547
00:50:58,212 --> 00:50:59,747
GOING TO TEACH US A LOT FOR THE

1548
00:50:59,747 --> 00:51:00,681
QUESTIONS YOU'RE ASKING.

1549
00:51:00,681 --> 00:51:02,082
>> WONDERFUL.

1550
00:51:02,082 --> 00:51:03,951
AND YOU READ MY MIND, I ALSO HAD

1551
00:51:03,951 --> 00:51:07,187
NEW MOM TO BE IN MY PURVIEW.

1552
00:51:07,187 --> 00:51:09,490
CAN YOU REMIND THE AUDIENCE THE

1553
00:51:09,490 --> 00:51:12,559
AGE AND SORT OF THE -- WHEN WE

1554
00:51:12,559 --> 00:51:15,662
MIGHT EXPECT TA THAT TYPE OF

1555
00:51:15,662 --> 00:51:16,897
RESEARCH CAN BE DONE

1556
00:51:16,897 --> 00:51:17,731
SPECIFICALLY IN THE NEW MOM TO

1557
00:51:17,731 --> 00:51:18,532
BE COHORT?

1558
00:51:18,532 --> 00:51:19,600
>> YEAH, THAT'S A GREAT

1559
00:51:19,600 --> 00:51:20,634
QUESTION.

1560
00:51:20,634 --> 00:51:22,636
I THINK THE MEAN AGE RIGHT NOW

1561
00:51:22,636 --> 00:51:23,737
FOR THE NEW MOM TO BE HEART

1562
00:51:23,737 --> 00:51:25,472
HEALTH STUDY PARTICIPANTS IS

1563
00:51:25,472 --> 00:51:29,043
SOMEWHERE AROUND 35 TO 40.

1564
00:51:29,043 --> 00:51:31,445
AND WE WOULD EXPECT MOST

1565
00:51:31,445 --> 00:51:34,314
INDIVIDUALS TO TRANSITION TO

1566
00:51:34,314 --> 00:51:36,050
MENOPAUSE SOMEWHERE BETWEEN 55

1567
00:51:36,050 --> 00:51:38,185
TO 60, ALTHOUGH PREMATURE

1568
00:51:38,185 --> 00:51:39,820
MENOPAUSE, I THINK TO HIGHLIGHT

1569
00:51:39,820 --> 00:51:41,889
YOUR POINT, OCCURRING EITHER

1570
00:51:41,889 --> 00:51:44,158
BEFORE 40 OR BEFORE 45, HAS ALSO

1571
00:51:44,158 --> 00:51:46,326
BEEN HIGHLIGHTED AS A

1572
00:51:46,326 --> 00:51:47,728
RISK-ENHANCING FACTOR FOR

1573
00:51:47,728 --> 00:51:48,629
CARDIOVASCULAR DISEASE, SO WE'RE

1574
00:51:48,629 --> 00:51:50,531
NOT THAT FAR AWAY FROM TRACKING

1575
00:51:50,531 --> 00:51:52,533
AND LOOKING AT THIS AND I KNOW

1576
00:51:52,533 --> 00:51:57,304
THEY ARE COLLECTING INFORMATION

1577
00:51:57,304 --> 00:51:59,807
ON PREGNANCY -- FOLLOW-UP

1578
00:51:59,807 --> 00:52:01,008
PREGNANCIES AS WELL AS ANY

1579
00:52:01,008 --> 00:52:01,975
MENOPAUSAL SYMPTOMS THAT MAY BE

1580
00:52:01,975 --> 00:52:04,711
COMING IN TERMS OF PERIOD

1581
00:52:04,711 --> 00:52:05,879
IRREGULARITY.

1582
00:52:05,879 --> 00:52:07,081
>> THANK YOU.

1583
00:52:07,081 --> 00:52:08,916
SO I SEE WE HAVE SEVERAL

1584
00:52:08,916 --> 00:52:11,218
QUESTIONS FROM THE AUDIENCE.

1585
00:52:11,218 --> 00:52:13,487
THE FIRST ONE, WHAT ROLE DOES

1586
00:52:13,487 --> 00:52:15,789
CVD SCREENING PLAY IN ENSURING

1587
00:52:15,789 --> 00:52:17,858
PATIENTS KNOW THEIR CVD STATUS?

1588
00:52:17,858 --> 00:52:20,094
AND DO YOU KNOW OF ANY VALIDATED

1589
00:52:20,094 --> 00:52:22,529
AND RECOMMENDED SCREENING TOOLS

1590
00:52:22,529 --> 00:52:24,832
WE SHOULD INCORPORATE INTO OUR

1591
00:52:24,832 --> 00:52:25,599
PERIPARTUM VISITS?

1592
00:52:25,599 --> 00:52:27,267
>> YEAH, I THINK THAT'S A
GREAT

1593
00:52:27,267 --> 00:52:27,701
QUESTION.

1594
00:52:27,701 --> 00:52:30,537
AND DEFINITELY AN AREA WHERE

1595
00:52:30,537 --> 00:52:32,539
HAVING GUIDELINES THAT ARE

1596
00:52:32,539 --> 00:52:34,875
SPECIFIC TO EXACTLY WHEN AN

1597
00:52:34,875 --> 00:52:36,643
INDIVIDUAL SHOULD HAVE

1598
00:52:36,643 --> 00:52:37,945
CARDIOVASCULAR DISEASE SCREENING

1599
00:52:37,945 --> 00:52:40,013
AFTER PREGNANCY COULD BE REALLY

1600
00:52:40,013 --> 00:52:40,547
HELPFUL.

1601
00:52:40,547 --> 00:52:43,450
RIGHT NOW, THE GENERAL GUIDANCE

1602
00:52:43,450 --> 00:52:46,220
OR RECOMMENDATION IS AFTER THAT

1603
00:52:46,220 --> 00:52:47,421
3 TO 6 MONTH POSTPARTUM PERIOD

1604
00:52:47,421 --> 00:52:49,223
TO CONSIDER AN ASSESSMENT OF

1605
00:52:49,223 --> 00:52:50,657
CARDIOVASCULAR DISEASE RISK

1606
00:52:50,657 --> 00:52:53,827
FACTORS AND I THINK THE LIFE'S

1607
00:52:53,827 --> 00:52:54,461
ESSENTIAL EIGHT CARDIOVASCULAR

1608
00:52:54,461 --> 00:52:55,529
HEALTH FRAMEWORK IS A GREAT WAY

1609
00:52:55,529 --> 00:52:57,264
TO APPROACH THAT TO CONSIDER

1610
00:52:57,264 --> 00:52:58,732
WHAT SOMEONE'S CARDIOVASCULAR

1611
00:52:58,732 --> 00:53:00,467
HEALTH SCORE IS AND GOING

1612
00:53:00,467 --> 00:53:03,103
THROUGH AND ASSESSING THAT AS A

1613
00:53:03,103 --> 00:53:05,672
WAY TO MEASURE CARDIOVASCULAR

1614
00:53:05,672 --> 00:53:07,274
HEALTH AND THINK ABOUT

1615
00:53:07,274 --> 00:53:08,876
INTERVENTIONS TO THEN IMPROVE

1616
00:53:08,876 --> 00:53:11,211
CARDIOVASCULAR HEALTH.

1617
00:53:11,211 --> 00:53:13,247
THE PREVENT RISK SCORE IS

1618
00:53:13,247 --> 00:53:14,581
ANOTHER WAY TO THINK WITH

1619
00:53:14,581 --> 00:53:15,849
PREDICTED RISK THAT CAN ALSO BE

1620
00:53:15,849 --> 00:53:18,385
DONE FOR ADULTS 30 AND OLDER.

1621
00:53:18,385 --> 00:53:21,088
>> GREAT, THANK YOU.

1622
00:53:21,088 --> 00:53:22,923
WHY OR HOW DO YOU THINK

1623
00:53:22,923 --> 00:53:25,526
LACTATION IS RELATED TO IMPROVED

1624
00:53:25,526 --> 00:53:26,126
CARDIOMETABOLIC HEALTH OTHER

1625
00:53:26,126 --> 00:53:27,728
THAN THROUGH WEIGHT LOSS

1626
00:53:27,728 --> 00:53:28,028
POSTPARTUM?

1627
00:53:28,028 --> 00:53:30,097
>> YEAH, I THINK THAT'S A
GREAT

1628
00:53:30,097 --> 00:53:30,964
QUESTION IN TERMS OF WHAT ARE

1629
00:53:30,964 --> 00:53:33,133
THE MECHANISMS THROUGH WHICH

1630
00:53:33,133 --> 00:53:34,835
LACTATION CAN IMPROVE

1631
00:53:34,835 --> 00:53:36,270
CARDIOMETABOLIC HEALTH AND I

1632
00:53:36,270 --> 00:53:38,138
THINK A LARGE PART OF IT IS

1633
00:53:38,138 --> 00:53:39,339
THROUGH THE ENERGY EXPENDITURE

1634
00:53:39,339 --> 00:53:42,009
THAT MAY BE RELATED TO WEIGHT

1635
00:53:42,009 --> 00:53:45,078
LOSS AND PARTICULARLY ACHIEVING

1636
00:53:45,078 --> 00:53:46,079
PREPREGNANCY WEIGHT, BECAUSE WE

1637
00:53:46,079 --> 00:53:47,948
KNOW THAT INDIVIDUALS WHO ARE

1638
00:53:47,948 --> 00:53:49,616
NOT ABLE TO RETURN TO THEIR

1639
00:53:49,616 --> 00:53:50,918
PREPREGNANCY WEIGHT OR HAVE

1640
00:53:50,918 --> 00:53:52,586
WEIGHT GAIN POSTPARTUM ARE MUCH

1641
00:53:52,586 --> 00:53:54,321
MORE LIKELY TO DEVELOP

1642
00:53:54,321 --> 00:53:56,023
HYPERTENSION AND DIABETES IN

1643
00:53:56,023 --> 00:54:00,194
THAT POSTPARTUM PERIOD.

1644
00:54:00,194 --> 00:54:00,961
>> GREAT.

1645
00:54:00,961 --> 00:54:02,596
YOU TOUCHED ON THIS A LITTLE BIT

1646
00:54:02,596 --> 00:54:04,164
ALREADY, BUT ARE THERE ANY

1647
00:54:04,164 --> 00:54:07,634
VALIDATED MEASURES FOR

1648
00:54:07,634 --> 00:54:08,302
CARDIOMETABOLIC DISEASE THAT WE

1649
00:54:08,302 --> 00:54:10,237
SHOULD USE TO TRACK A PATIENT'S

1650
00:54:10,237 --> 00:54:13,807
PROGRESS AND HAS LIFE'S

1651
00:54:13,807 --> 00:54:15,309
ESSENTIAL 8 BEEN USED FOR THAT

1652
00:54:15,309 --> 00:54:16,643
PURPOSE, BEEN VALIDATED FOR THIS

1653
00:54:16,643 --> 00:54:16,877
PURPOSE?

1654
00:54:16,877 --> 00:54:17,945
>> THAT'S A GREAT
QUESTION.

1655
00:54:17,945 --> 00:54:19,913
I THINK THE LIFE'S ESSENTIAL

1656
00:54:19,913 --> 00:54:22,549
8 SCORE IS A GREAT ONE TO ANCHOR

1657
00:54:22,549 --> 00:54:25,886
ON BECAUSE IT HELPS TO CREATE A

1658
00:54:25,886 --> 00:54:27,521
COMPOSITE SCORE AROUND THE

1659
00:54:27,521 --> 00:54:28,622
CARDIOMETABOLIC FACTORS.

1660
00:54:28,622 --> 00:54:30,357
THE CARDIOVASCULAR KIDNEY

1661
00:54:30,357 --> 00:54:31,291
METABOLIC CONSTRUCT THAT I

1662
00:54:31,291 --> 00:54:33,927
INTRODUCED AT THE END REALLY

1663
00:54:33,927 --> 00:54:35,996
INTEGRATES THE LIFE'S ESSENTIAL

1664
00:54:35,996 --> 00:54:37,598
8 IN CARDIOVASCULAR HEALTH SCORE

1665
00:54:37,598 --> 00:54:39,333
WITH QUANTITATIVE RISK SCORING

1666
00:54:39,333 --> 00:54:41,535
FROM PREVENT TO ALLOW A MORE

1667
00:54:41,535 --> 00:54:42,636
QUALITATIVE STAGING APPROACH,

1668
00:54:42,636 --> 00:54:44,104
WITH YOU MAY BE CONSIDERED, BUT

1669
00:54:44,104 --> 00:54:46,306
I THINK RIGHT NOW, WE HAVE MUCH

1670
00:54:46,306 --> 00:54:47,941
MORE DATA ON THE LIFE'S

1671
00:54:47,941 --> 00:54:51,845
ESSENTIAL 8 SCORING APPROACH.

1672
00:54:51,845 --> 00:54:53,146
>> GREAT.

1673
00:54:53,146 --> 00:54:55,782
LET'S SEE.

1674
00:54:55,782 --> 00:54:57,751
ONE AUDIENCE MEMBER STATED THANK

1675
00:54:57,751 --> 00:54:59,886
YOU FOR A WONDERFUL LIFE COURSE

1676
00:54:59,886 --> 00:55:01,321
DISCUSSION AROUND PREGNANCY AND

1677
00:55:01,321 --> 00:55:02,522
PREGNANCY OUTCOMES.

1678
00:55:02,522 --> 00:55:04,825
WHAT DO YOU FEEL IS THE MOST

1679
00:55:04,825 --> 00:55:05,759
PROMISING INTERVENTION DURING

1680
00:55:05,759 --> 00:55:07,628
THE PREPREGNANCY OR

1681
00:55:07,628 --> 00:55:08,395
INTERPREGNANCY PERIODS TO

1682
00:55:08,395 --> 00:55:10,597
PREVENT OR REDUCE RISK FOR LONG

1683
00:55:10,597 --> 00:55:12,099
TERM CARDIOVASCULAR HEALTH IN

1684
00:55:12,099 --> 00:55:13,700
WOMEN WHO EXPERIENCE APOs

1685
00:55:13,700 --> 00:55:14,368
DURING PREGNANCY?

1686
00:55:14,368 --> 00:55:16,003
WOULD THIS INCLUDE MEDICATIONS,

1687
00:55:16,003 --> 00:55:17,371
ESSER SEISE, DIET OR ANYTHING

1688
00:55:17,371 --> 00:55:17,571
ELSE?

1689
00:55:17,571 --> 00:55:19,439
>> IT'S A REALLY, REALLY
TOUGH

1690
00:55:19,439 --> 00:55:20,874
QUESTION, AND I THINK THE ANSWER

1691
00:55:20,874 --> 00:55:25,879
IS PROBABLY COMPLICATED AND

1692
00:55:25,879 --> 00:55:26,847
PERHAPS ONE OF THE THINGS THAT

1693
00:55:26,847 --> 00:55:28,548
MAY BE MOST HELPFUL IS THINKING

1694
00:55:28,548 --> 00:55:29,883
ABOUT A BIT OF A PRECISION

1695
00:55:29,883 --> 00:55:32,686
APPROACH WITH THIS QUESTION.

1696
00:55:32,686 --> 00:55:34,321
SO ARE THERE STRATEGIES THAT MAY

1697
00:55:34,321 --> 00:55:36,189
BE MORE TAILORED TO SPECIFIC

1698
00:55:36,189 --> 00:55:37,891
INDIVIDUALS THAT COULD HELP WITH

1699
00:55:37,891 --> 00:55:39,426
THIS, AND I THINK ABOUT

1700
00:55:39,426 --> 00:55:41,194
INDIVIDUALS WHO HAVE MAYBE

1701
00:55:41,194 --> 00:55:42,629
SIGNAL OF ELEVATED BLOOD

1702
00:55:42,629 --> 00:55:45,232
PRESSURE AND THINKING ABOUT LOW

1703
00:55:45,232 --> 00:55:46,500
SODIUM DIET INTERVENTION AND

1704
00:55:46,500 --> 00:55:48,502
PHYSICAL ACTIVITY INTERVENTION

1705
00:55:48,502 --> 00:55:50,237
VERSUS AN INDIVIDUAL WHO MAYBE

1706
00:55:50,237 --> 00:55:53,140
HAS SEVERE OBESITY AND ARE THERE

1707
00:55:53,140 --> 00:55:54,441
MEDICATIONS PARTICULARLY AS WE

1708
00:55:54,441 --> 00:55:57,978
LEARN MORE ABOUT GLUCAGON

1709
00:55:57,978 --> 00:55:59,746
RECEPTOR PEPTIDE ONE AGONISTS AS

1710
00:55:59,746 --> 00:56:01,415
A POTENTIAL APPROACH FOR

1711
00:56:01,415 --> 00:56:02,949
CONSIDERING EARLIER INTERVENTION

1712
00:56:02,949 --> 00:56:04,251
OR SHORT TERM USE IN THE SETTING

1713
00:56:04,251 --> 00:56:05,652
OF SEVERE OBESITY.

1714
00:56:05,652 --> 00:56:08,055
SO I THINK REALLY GOOD QUESTION,

1715
00:56:08,055 --> 00:56:09,723
AND PERHAPS ONE WHERE WE REALLY

1716
00:56:09,723 --> 00:56:13,827
NEED TO FOCUS A LOT OF THOUGHT

1717
00:56:13,827 --> 00:56:15,262
IN TERMS OF HOW WE WOULD EVEN

1718
00:56:15,262 --> 00:56:16,563
DESIGN THESE TYPES OF TRIALS

1719
00:56:16,563 --> 00:56:19,232
GIVEN THE CHALLENGE OF

1720
00:56:19,232 --> 00:56:19,800
IDENTIFYING PRE-PREGNANT

1721
00:56:19,800 --> 00:56:20,567
INDIVIDUALS AND THEN CONSIDERING

1722
00:56:20,567 --> 00:56:22,502
HOW WE WOULD MACH TRIAL DESIGN

1723
00:56:22,502 --> 00:56:23,704
WITH THE PHENOTYPE OF THE

1724
00:56:23,704 --> 00:56:27,607
INDIVIDUAL.

1725
00:56:27,607 --> 00:56:29,843
>> ANOTHER AUDIENCE MEMBER
SAYS

1726
00:56:29,843 --> 00:56:30,477
GREAT PRESENTATION.

1727
00:56:30,477 --> 00:56:32,546
IT WAS FASCINATING TO SEE THE

1728
00:56:32,546 --> 00:56:33,747
GRAPH IN THE STUDY SHOWING THE

1729
00:56:33,747 --> 00:56:40,053
BURDEN OF YOUNGER GENERATIONS AE

1730
00:56:40,053 --> 00:56:40,520
HAVING.

1731
00:56:40,520 --> 00:56:42,122
DO YOU NOW STUDIES THAT EXPLORE

1732
00:56:42,122 --> 00:56:45,192
THE DIFFERENT RISK FACTOR BURDEN

1733
00:56:45,192 --> 00:56:45,859
AMONG GENERATIONS?

1734
00:56:45,859 --> 00:56:47,794
>> IT'S A GREAT QUESTION.

1735
00:56:47,794 --> 00:56:50,497
I THINK THERE'S BEEN KIND OF --

1736
00:56:50,497 --> 00:56:52,232
PERHAPS SOME OBSERVATIONAL

1737
00:56:52,232 --> 00:56:53,200
ANALYSES THAT COULD BE

1738
00:56:53,200 --> 00:56:54,534
CONSIDERED THINKING ABOUT THAT,

1739
00:56:54,534 --> 00:56:56,136
LIKE THE COLLABORATIVE PERINATAL

1740
00:56:56,136 --> 00:56:59,740
PROJECT OR CPP IS ONE THAT'S

1741
00:56:59,740 --> 00:57:01,274
FROM FIVE DECADES AGO, AND IF WE

1742
00:57:01,274 --> 00:57:03,443
COMPARE THAT TO SOME

1743
00:57:03,443 --> 00:57:04,511
CONTEMPORARY COHORTS TODAY, WE

1744
00:57:04,511 --> 00:57:06,179
MAY BE ABLE TO SEE SOME

1745
00:57:06,179 --> 00:57:06,613
PATTERNS.

1746
00:57:06,613 --> 00:57:08,148
ONE OF THE BIGGEST CHALLENGES IS

1747
00:57:08,148 --> 00:57:09,616
THAT DEFINITION OF SOME OF THESE

1748
00:57:09,616 --> 00:57:10,417
COMPLICATIONS HAS CHANGED OVER

1749
00:57:10,417 --> 00:57:11,685
TIME AS WELL.

1750
00:57:11,685 --> 00:57:13,520
IN MORE RECENT YEARS OR RECENT

1751
00:57:13,520 --> 00:57:14,621
GENERATIONS, I DON'T THINK THAT

1752
00:57:14,621 --> 00:57:16,590
THAT'S THE DRIVER, BUT WE REALLY

1753
00:57:16,590 --> 00:57:18,258
NEED LONGITUDAL OBSERVATIONAL

1754
00:57:18,258 --> 00:57:20,594
DATA THAT ALLOW US TO FOLLOW THE

1755
00:57:20,594 --> 00:57:22,462
SAME INDIVIDUAL TO BETTER

1756
00:57:22,462 --> 00:57:24,898
UNDERSTAND IF THOSE RISK FACTOR

1757
00:57:24,898 --> 00:57:27,134
CHANGES ARE WHAT ARE ASSOCIATED

1758
00:57:27,134 --> 00:57:30,837
WITH INCREASING RISK.

1759
00:57:30,837 --> 00:57:33,340
>> GREAT.

1760
00:57:33,340 --> 00:57:36,076
SOMEONE HAS RAISED THE QUESTION

1761
00:57:36,076 --> 00:57:37,344
AROUND TOBACCO, THIS IS GREAT.

1762
00:57:37,344 --> 00:57:38,345
THEY SAY GREAT TALK.

1763
00:57:38,345 --> 00:57:41,715
CAN YOU COMMENT ON THE ROLE OF

1764
00:57:41,715 --> 00:57:42,616
SMOKING, TOBACCO CESSATION IN

1765
00:57:42,616 --> 00:57:44,751
THE EARLY PREVENTION OF

1766
00:57:44,751 --> 00:57:45,419
CARDIOVASCULAR HEALTH IN MOTHERS

1767
00:57:45,419 --> 00:57:45,786
AND CHILDREN?

1768
00:57:45,786 --> 00:57:47,387
>> YEAH, I THINK THIS IS A
GREAT

1769
00:57:47,387 --> 00:57:51,925
QUESTION AND ONE WHERE WE'VE HAD

1770
00:57:51,925 --> 00:57:53,226
A LOT OF SUCCESS IN TERMS OF

1771
00:57:53,226 --> 00:57:55,529
TOBACCO CESSATION AND NOW

1772
00:57:55,529 --> 00:57:57,731
PERHAPS WITH VAPING AND

1773
00:57:57,731 --> 00:57:58,865
E-CIGARETTES, WE'RE SEEING AN

1774
00:57:58,865 --> 00:58:00,167
INCREASING PREVALENCE AGAIN IN

1775
00:58:00,167 --> 00:58:03,136
YOUNG ADULTS OF USE OF TOBACCO

1776
00:58:03,136 --> 00:58:06,106
OR E-CIGARETTE PRODUCTS.

1777
00:58:06,106 --> 00:58:07,140
WE KNOW THOSE ARE ASSOCIATED

1778
00:58:07,140 --> 00:58:08,742
WITH POOR CARDIOVASCULAR HEALTH

1779
00:58:08,742 --> 00:58:09,910
AND I THINK WE'RE STILL

1780
00:58:09,910 --> 00:58:11,711
GENERATING EVIDENCE IN TERMS OF

1781
00:58:11,711 --> 00:58:12,345
UNDERSTANDING SPECIFICALLY FOR

1782
00:58:12,345 --> 00:58:14,648
TOBACCO AND MARIJUANA USE AND

1783
00:58:14,648 --> 00:58:16,283
OTHER E-CIGARETTES THE EXACT

1784
00:58:16,283 --> 00:58:17,818
IMPACT ON CARDIOVASCULAR HEALTH

1785
00:58:17,818 --> 00:58:18,919
FOR BIRTHING INDIVIDUALS AND

1786
00:58:18,919 --> 00:58:20,187
OFFSPRING, BUT I THINK THIS IS A

1787
00:58:20,187 --> 00:58:21,087
REALLY IMPORTANT AREA OF

1788
00:58:21,087 --> 00:58:23,457
RESEARCH.

1789
00:58:23,457 --> 00:58:25,692
>> I THINK WE HAVE TIME
FOR ONE

1790
00:58:25,692 --> 00:58:27,093
QUICK QUESTION.

1791
00:58:27,093 --> 00:58:30,030
IN THE RESEARCH YOU MENTIONED,

1792
00:58:30,030 --> 00:58:32,732
IS CAROTID ULTRASOUND USED FOR

1793
00:58:32,732 --> 00:58:34,134
ALL PREGNANT PEOPLE OR ONLY

1794
00:58:34,134 --> 00:58:35,569
THOSE WITH CARDIOVASCULAR

1795
00:58:35,569 --> 00:58:36,203
SYMPTOMS DURING PREGNANCY?

1796
00:58:36,203 --> 00:58:37,137
>> GREAT QUESTION.

1797
00:58:37,137 --> 00:58:39,806
SO THAT ANCILLARY STUDY IS BEING

1798
00:58:39,806 --> 00:58:41,575
DONE IN THE NEW MOM TO BE HEART

1799
00:58:41,575 --> 00:58:43,810
HEALTH STUDY, AND I SEE A

1800
00:58:43,810 --> 00:58:44,411
QUESTION DESCRIBING THIS, SO

1801
00:58:44,411 --> 00:58:46,880
THIS WAS A STUDY WHERE 10,000

1802
00:58:46,880 --> 00:58:48,415
INDIVIDUALS WERE FIRST RECRUITED

1803
00:58:48,415 --> 00:58:51,251
IN 2010 IN THE FIRST TRIMESTER

1804
00:58:51,251 --> 00:58:52,986
OF THEIR PREGNANCY ACROSS EIGHT

1805
00:58:52,986 --> 00:58:54,154
SITES IN THE UNITED STATES.

1806
00:58:54,154 --> 00:58:56,656
AT ABOUT TWO TO SEVEN YEARS,

1807
00:58:56,656 --> 00:58:58,492
4,000 OF THEM WERE THEN

1808
00:58:58,492 --> 00:59:01,862
RE-EXAMINED, AND NOW THERE'S A

1809
00:59:01,862 --> 00:59:03,296
SECOND IN-PERSON VISIT THAT'S

1810
00:59:03,296 --> 00:59:04,264
HAPPENING WHERE EVERYONE WHO WAS

1811
00:59:04,264 --> 00:59:05,565
PART OF THAT COHORT IS BEING

1812
00:59:05,565 --> 00:59:07,200
INVITED TO HAVE A CAROTID

1813
00:59:07,200 --> 00:59:08,401
ULTRASOUND WITH THE GOAL TO THEN

1814
00:59:08,401 --> 00:59:10,270
BE ABLE TO EXAMINE THE

1815
00:59:10,270 --> 00:59:11,238
ASSOCIATION BETWEEN ADVERSE

1816
00:59:11,238 --> 00:59:13,507
PREGNANCY OUTCOMES AND THEIR

1817
00:59:13,507 --> 00:59:16,009
VASCULAR INJURY OR POTENTIAL FOR

1818
00:59:16,009 --> 00:59:20,614
INJURY AND ATHEROSCLEROSIS

1819
00:59:20,614 --> 00:59:20,814
TODAY.

1820
00:59:20,814 --> 00:59:21,481
>> WONDERFUL.

1821
00:59:21,481 --> 00:59:22,716
WELL, THANK YOU ALL TO EVERYONE

1822
00:59:22,716 --> 00:59:24,518
WHO JOINED US TODAY AND DURING

1823
00:59:24,518 --> 00:59:26,686
THE ONPA SEMINARS THIS YEAR.

1824
00:59:26,686 --> 00:59:28,088
COULD WE PLEASE BRING UP THE

1825
00:59:28,088 --> 00:59:38,365
LAST TWO SLIDES?

1826
00:59:42,269 --> 00:59:42,636
GREAT.

1827
00:59:42,636 --> 00:59:44,471
SO WE WILL BE BACK ON

1828
00:59:44,471 --> 00:59:46,540
SEPTEMBER 9TH AT 11:00 A.M.

1829
00:59:46,540 --> 00:59:50,277
EASTERN TIME, WHEN DR. KARYN

1830
00:59:50,277 --> 00:59:52,178
ESSER WILL PRESENT ON CIRCADIAN

1831
00:59:52,178 --> 00:59:54,214
CLOCKS AND EXERCISE, PARTNERS IN

1832
00:59:54,214 --> 00:59:55,949
HEALTH, OPEN TO THE PUBLIC

1833
00:59:55,949 --> 00:59:57,117
THROUGH NIH VIDEOCAST.

1834
00:59:57,117 --> 00:59:58,218
IF YOU HAVE ANY SUGGESTIONS FOR

1835
00:59:58,218 --> 00:59:59,185
TOPICS OR SPEAKERS YOU WOULD

1836
00:59:59,185 --> 01:00:03,089
LIKE TO HEAR, FEEL FREE TO EMAIL

1837
01:00:03,089 --> 01:00:06,293
THEM TO ONPA@MAIL.NIH.GOV.

1838
01:00:06,293 --> 01:00:07,494
THANK YOU AGAIN DR. KHAN FOR

1839
01:00:07,494 --> 01:00:08,461
SHARING YOUR INSIGHTS ON THIS

1840
01:00:08,461 --> 01:00:08,895
IMPORTANT TOPIC.

1841
01:00:08,895 --> 01:00:10,530
HAVE A GREAT REST OF THE DAY,

1842
01:00:10,530 --> 01:00:10,797
EVERYONE!

1843
01:00:10,797 --> 01:00:21,041
>> THANK YOU.