Cardiovascular Disease and Maternal Mortality

More than 30 years after the CDC first initiated a national Pregnancy Mortality Surveillance System, the number of reported pregnancy-related deaths have continued to steadily rise, particularly among minority populations. Cardiovascular and cerebrovascular diseases (CCVDs) remain the leading cause of maternal mortality in the first year after delivery. Pregnant women with pre-eclampsia are at particularly high risk for complications, and have higher risk of CCVDs later in life. Yet, the physiological mechanisms that contribute to increased CCVD risk in these women remain poorly understood, and the optimal clinical pathways for reducing postpartum CCVD risk are not yet defined. Thus, Dr. Eliza Miller, together with colleagues from the Departments of Obstetrics and Gynecology, Anesthesiology, and Medicine, formed a Preeclampsia Working Group to brainstorm new hypothesis-driven research and resource sharing. From this group came the Motherhealth Study (MHS), an observational cohort study of women with and without pre-eclampsia, followed for up to 24 months after delivery, funded through the Precision Medicine Joint Pilot Grants Program. The goal of the MHS, according to Dr. Miller (study PI) is to “demonstrate feasibility and collect pilot data to guide effect estimates for the planning of a future larger study involving multiple centers and longer-term follow-up.” Now published online in BMJ Open, Miller et al. describe the MHS methods and protocol, outlining the multidisciplinary approach and detailed physiological profiling that aims to result in robust pilot data for future interventional studies.

Social isolation is linked to higher morbidity and all-cause mortality in the general population. Individuals with multiple sclerosis (MS) are at heightened risk for social isolation due to having a chronic disease. In two independent cohorts of patients with MS (total N=247), Dr. Anne Kever, a postdoctoral fellow in Dr. Vicky Leavitt’s lab, examined relationships of social support to clinical outcomes, finding that stronger social support was associated with less depressive symptoms, less anxiety, lower levels of fatigue, higher quality of life, and better subjective cognitive function. As recently reported in the Journal of Neurology, in the early MS cohort (within 5 years of disease diagnosis; N=185), social support was associated with motor outcomes: stronger grip strength, fine graphomotor dexterity, and faster walking speed. Consistent with bioevolutionary theory proposing social support to be more critical for survival in women than men, these motor relationships were stronger in women. Importantly, social support was not related to disease burden (T2 lesion volume) or disability (EDSS), arguing against worse overall disease as a mediator of social support and clinical/functional outcomes.

Across multiple long-term health conditions with pediatric onset, there is well-documented evidence that early adulthood represents a critical transitional period during which medical follow-up is frequently compromised or lost. Around age 21, congenital HIV patients, in particular, demonstrate decreased ability to maintain their complex treatment regimens, due to a variety of factors including psychiatric illness and environmental and psychosocial issues. The aim of a new study by senior author Dr. Kiran Thakur and colleagues, including first author and former VP&S medical student Dr. Caleb McEntire, was to describe the natural history of individuals in their late teens to early twenties with congenital HIV who develop JC virus (JCV)—a virus that can cause opportunistic infection in the brain—after self-discontinuing combined antiretroviral therapy (cART). As recently reported in the AIDS Journal, of the 10 patients studied, nine were further diagnosed with progressive multifocal leukoencephalopathy (PML) and one with JCV granule cell neuronopathy (JCV GCN). The authors note that “as more therapies for PML are developed, characterizing the natural history of disease in vulnerable groups will be helpful in determining effective and individualized treatment plans, both during the transition from pediatric to adult care specifically and throughout the course of the disease.”