1 Simple Question That Could Improve Women’s Health | Meryam Sugulle | TED

翻译人员: Fangxi Qin 校对人员: Jinnie Sun

How would you react if I told you that we have an underused screening tool

如果我告诉你，我们有一个 筛查工具尚未完全发挥用处，

that has the potential to improve women's health substantially?

但它有显著的改善女性健康的可能性， 你会是什么反应？

And that this tool only consists of one simple question.

这个工具只包含一个简单的问题。

Have you had any pregnancy complications?

你有妊娠并发症吗？

With that simple question,

只要问这一个简单的问题，

we could identify women at increased risk for cardiovascular disease

我们就可以确定哪些女性

later in their lives.

晚年患心血管疾病的风险更高。

That means diseases involving the heart, the brain

那包括心脏、大脑、

and the blood vessels,

和血管相关的疾病，

like heart attack, heart failure, stroke and high blood pressure.

例如心脏病、心力衰竭、中风和高血压。

By asking that simple question,

通过问这个简单的问题，

we could seek out the women

我们可以找到那些女性，

who could benefit from general health screening

她们可以在还年轻的时候，

already at a younger age.

就从普通的健康检查中受益。

That means checkups of blood pressure, body weight and blood sugar.

也就是血压、体重和血糖检查。

Based on the results, we could offer personalized lifestyle advice

根据结果，我们可以提供 个性化的生活方式建议，

and suggest preventive measures.

并提出预防措施。

Why?

为什么？

For this is a fact:

因为这个事实：

cardiovascular disease is a major cause of early death, apart from cancer,

除癌症外，心血管疾病 是导致早逝的主要原因，

not only for men, but also for women.

不仅对于男性，对女性也是如此。

I hope that all of you now got very curious

但愿你们现在都很好奇，

about what on Earth nine months of pregnancy

到底九个月的妊娠

have to do with older women getting heart attacks and strokes.

与老年妇女的心脏病和 中风有什么关系。

Pregnancy is something younger people do, you might think,

人们可能会认为， 怀孕是年轻人的事情，

even though I would argue that 50 is the new 30.

不过我会说，五十岁是新的三十岁。

(Laughter)

（笑声）

Pregnancy is often described by a well-used quote

人们常常把怀孕形容为

as a stress test for life.

人生的压力测试。

A woman's health gets tested by being pregnant.

怀孕会对女性的健康进行测试。

Will she tolerate pregnancy

她能否能够承受怀孕，

and all the involved physiological changes well,

以及怀孕带来的所有生理变化？

or will there be any complications?

还是会出现任何并发症？

The most important organ for pregnancy

怀孕中最重要的器官，

is the one that was once attached to the center of your belly,

附着在腹部中央，

where your belly button is.

在你肚脐的位置。

We all have a belly button, regardless of gender.

无论哪种性别，所有人都有肚脐。

You and I, King Charles, the Pope, Beyoncé.

你，我，查尔斯国王，教皇，碧昂斯。

And where it is, we were all once connected

在这，我们都曾通过 同样的一条生命线，

via a lifeline, the umbilical cord,

脐带，

to the most important organ in both our and our mother's life.

将我们与母亲最重要的器官相连。

You and I, we are all here thanks to our placenta.

我们之所以能在这里， 要感谢我们的胎盘。

We all survived the single most dangerous event in our life,

我们之所以能从生命中 最危险的一件事中存活下来，

birth, that is,

也就是出生，

due to our well-enough functioning placenta.

正是因为我们功能良好的胎盘。

We all know that the placenta was our first meal box

我们都知道，当我们还是 母亲子宫里成长的婴儿时，

when we were growing babies inside our mother's womb.

胎盘是我们的第一个餐盒。

Most of us also know

我们大多数人还知道，

that the approximately nine months of growth

我们在母亲子宫内

inside our mothers' womb

大约九个月的生长，

have lifelong, lasting effects

会对我们出生后的健康和疾病情况，

on our health and diseases once we are outside.

有终身的影响。

But what is lesser-known is that the placenta,

但鲜为人知的是，胎盘，

the one we were attached to,

我们所附着的胎盘，

is crucial for the future cardiovascular health of the mother

是母亲在她的子宫内 借给我们的房间，

who lent us a room in her womb.

它对于母亲未来的 心血管健康至关重要。

That means how healthy our placenta was

也就是说着我们胎盘的健康程度

is very important for the health of our mother's heart and blood vessels.

对我们母亲的心脏和血管的健康非常重要。

How is that the case?

为什么呢？

How does our placenta

我们的胎盘，

affect our mother's future cardiovascular health?

如何影响母亲未来的心血管健康？

In order to understand that,

为了理解这一点，

we must briefly talk about the makeup of a healthy placenta.

我们需要简单说一下健康胎盘的构成。

This fascinating organ is made early on in pregnancy,

这一神奇的器官是在怀孕初期形成的，

when the fertilized egg develops into the baby

这时受精卵发育成了婴儿，

and into cells that invade the layers of the womb of the mother.

然后变成侵入母亲子宫各层的细胞。

This happens early on in pregnancy, before the baby even looks like a baby.

这种入侵发生在怀孕初期， 此时胎儿看起来还不像个胎儿。

After invading the different wall layers of the mother's womb,

在侵入母亲子宫的不同壁层后，

the cells group together and form finger-shaped tissue.

这些细胞聚集在一起， 形成手指状的组织。

These tissue fingers seem to poke into the layers.

这些手指组织会看起来是戳入了壁层。

Finally, the healthy placenta includes a special room

最终，健康的胎盘 会有一个特殊的房间，

where these tissue fingers are showered in the mother's blood.

让这些手指组织 充分浸润在母亲的血液中。

In this shower room,

在这个淋浴房里，

the growing baby receives different life-important nutrients and signals

成长中的宝宝会通过不同的传输机制

via different transport mechanisms.

接受维持生命的营养和信号。

In other words, it is very important

换句话说，至关重要的是

that everything works well in this specialized room.

在这个特殊的房间中， 一切都运作良好。

It has to be nice and tidy.

这个房间必须漂亮整洁，

That guarantees the meal box effect of the placenta.

以保证胎盘的餐盒效果，

The good effect.

良好的效果。

But just like almost every other living things,

但就和几乎所有其他生物一样，

cells can get stressed, and cells can get out of control.

细胞会有压力，细胞会失控。

This happens, for example, in cancer.

像癌症就是这种情况。

But how can a healthy placenta become a stressed placenta?

但是，健康的胎盘 怎么会变成压力下的胎盘呢？

What happens?

发生了什么？

Placental cells can get stressed

当用来沐浴血液的房间变得混乱时，

when the blood shower in the specialized room gets messy.

胎盘细胞可能会受到压力。

The placental cells then get out of control.

然后胎盘细胞就会失控。

They grow crazy bumps on their surface.

它们表面会长出疯狂的肿块。

In fact, they seem to literally throw up stuff into the specialized room.

而它们似乎是真的会把这些东西 扔到专门的房间里。

By that, the stressed placental cells send many different types of signals

以此，受压力的胎盘细胞 发送许多不同的信号

into the specialized room.

到专门的房间。

And these stress signals then reach the mother's blood

这些压力信号就会传送到母亲的血液

and the mother's blood vessels.

和母亲的血管。

And when they reach the mother's blood vessels,

当它们到达母亲的血管时，

they can make these vessels unhealthy,

就会使这些血管变得不健康，

and they can contribute to making the pregnant woman sick,

也可能增加孕妇的得病风险，

and the pregnancy gets complicated.

并导致整个孕程变得复杂。

The placenta is then not really healthy anymore.

胎盘从此就不再健康了。

Maybe you've heard of or even know personally,

也许你已经听说过，甚至自己就认识，

women who have had increased blood pressure

那些从怀孕中期开始

from around the middle of pregnancy,

就有血压升高问题的女性，

who had protein in their urine or headache,

她们的尿液中有蛋白质，

abdominal pain, blurred vision

或者她们有头痛、腹痛、视力模糊

or all of this.

或所有这些问题。

Then they had what we call preeclampsia,

然后她们会得一种 叫做先兆子痫的病症，

a pregnancy complication of varied severity

这是一种有不同 严重程度的妊娠并发症，

that occurs in three to 10 percent of all pregnant women,

在所有孕妇中的发病率为 3％ 到 10％ ，

the rate depending on where we live.

这一概率取决于我们生活的地方。

What does preeclampsia have to do with the placenta

先兆子痫与胎盘，

and with the mother's future cardiovascular health?

和母亲未来的心血管健康有什么关系？

Remember what I told you about the stressed placenta?

还记得我说的，胎盘会处于压力中吗？

According to a widely accepted theory supported by research,

根据一个由研究证实 且被广泛接受的理论，

in preeclampsia the stressed placental cells

在先兆子痫中，处于压力的胎盘细胞

send signals into the mother's blood.

向母亲的血液发送信号。

These stress signals may cause inflammation-like processes

这些压力信号可能会导致 类似炎症的过程

in the inner lining of the mother's blood vessels.

在母亲血管内膜出现。

This then leads to disturbed vessel function

然后还会导致血管功能受损，

and to the signs of preeclampsia that I mentioned earlier.

并出现我之前提到的先兆子痫症状。

Preeclampsia is only one of several examples

在与胎盘功能不佳相关的妊娠并发症中，

for a pregnancy complication related to a not-well-working placenta,

先兆子痫只是例子之一，

but I will stick to this example.

在这里我先继续用它举例。

In a way,

从某种意义上说，

the placenta and the mother talk to each other.

胎盘和母亲是相互交谈的。

And since our earliest cells

从最早开始，

formed both us, the babies, and the placenta,

细胞形成了婴儿的我们和胎盘，

we talked to our mothers even before we could speak properly.

我们就开始和母亲进行交谈， 在我们能说话之前。

And it turns out that this may well be

事实上这很可能是

one of the more important talks we had with our mothers.

我们与母亲进行的最重要的谈话之一。

So back to the concept of pregnancy as a stress test for life

说回怀孕作为生活压力测试的概念，

and how stressed placental cells

以及受到压力的胎盘细胞会怎么

can impact on a mother’s future cardiovascular health,

在母亲怀孕并患有先兆子痫几十年后，

decades after she was pregnant and had preeclampsia.

影响她的心血管健康。

How do we know that women after pregnancy complications

我们是怎么知道有妊娠并发症的女性

are at increased risk for future cardiovascular disease?

患心血管疾病的风险会增加？

In Scandinavia, we have unique access to large population-based data sets

在斯堪的纳维亚， 我们有一个大型数据集，

containing health information.

涵盖人口健康信息。

For many decades,

几十年来，

these databases have provided important medical knowledge.

这些数据提供了重要的医学知识，

They tell us that women who have had preeclampsia

并告诉我们，相比于 无妊娠并发症的女性，

towards the end of pregnancy

在妊娠末期，

have a doubled risk for future cardiovascular disease,

患有先兆子痫的女性

compared to women who have had uncomplicated pregnancies.

未来患心血管疾病的风险翻了一番。

I mentioned the meal box function of the placenta.

前面我们说到了胎盘的餐盒功能。

I explained the effect of stressed placental cells

我解释了受压力的胎盘细胞的影响，

and how they send signals to the mother.

以及它们如何向母亲发送信号。

If the placenta gets even more stressed,

如果胎盘受到更大的压力，

the meal box function may be affected.

餐盒的功能可能会受到影响。

That means the baby has a lower weight than it should have,

这意味着除了女性患先兆子痫外，

in addition to the woman developing preeclampsia.

婴儿的体重也低于应有的体重。

Some babies may even, for various reasons,

由于各种原因，

be born too early, prematurely.

有些婴儿甚至可能会早产。

For these women

对于这些胎盘压力非常大的女性，

with a very, very stressed placenta,

数据库告诉我们，

the databases tell us

与无并发症妊娠的女性相比，

that the future cardiovascular disease risk is even higher,

她们未来的心血管疾病风险甚至更高，

up to four to eightfold higher compared to women with uncomplicated pregnancies.

最多可高出四到八倍。

So to sum up what we have talked about so far,

因此，总结一下我们目前说过的内容，

we have databases that give us information on pregnancy complications

我们有数据库为我们提供有关妊娠并发症，

and future cardiovascular health risks.

和未来心血管健康风险的信息。

We know that the baby and the placenta and the mother

我们知道宝宝、胎盘和母亲，

send messages to each other, talk to each other during pregnancy,

在怀孕期间会互相发送信息，互相交谈，

but we do not know the exact mechanisms

但我们还不知道究竟是什么样的机制

by which complicated pregnancy and the placenta

导致复杂的妊娠情况，

contribute to future health risks for women.

使得胎盘影响了女性未来健康风险。

And this is my point.

这是我想表达的重点。

Much research remains to be done,

我们仍需要进行许多研究，

and the placenta is still full of secrets that need to be unveiled.

胎盘仍然有许多待揭露的秘密。

But why should we bother anyhow?

但是我们为什么要为此努力呢？

And how can we identify women at increased risk?

以及我们如何识别风险较高的女性？

And what should we do then?

我们该怎么做呢？

As I said in the beginning.

正如我一开始所说。

Why? Because cardiovascular diseases

为什么要做这些？ 因为心血管疾病

are a main cause for early death also in women.

是女性早逝的主要原因。

Heart attacks are known to present differently in women

众所周知，女性的心脏病

compared to men,

与男性不同，

and may be recognized too late,

被发现时可能为时已晚，

and that might prove fatal.

甚至会致命。

This is also another good reason

这也是在更早期、更年轻时，

for identifying women at increased risk earlier, at a younger age.

就应该鉴别出高风险女性的 另一个好理由。

This is because the earlier the risk factors are dealt with,

因为越早处理风险因素，

the better the effect on the blood vessels and the heart.

对血管和心脏就有越好的干预效果。

How can we identify women at increased risk?

我们如何识别风险较高的女性？

By asking the right questions about pregnancy at the right time,

在正确的时间问询 关于怀孕的正确问题，

and whatever the exact cause and the precise mechanism

无论妊娠并发症与心血管疾病之间

for the association between pregnancy complications

确切的关联原因机制

and cardiovascular disease prove to be,

究竟是什么，

our mothers', sisters', aunts' pregnancy history

我们的母亲、姐妹、阿姨的妊娠史

may provide important information for future health needs.

都能够为未来的健康需求 提供重要信息。

And what should we do then?

我们该怎么做？

We could take action at the right time.

我们可以在正确的时间采取行动。

Women could be offered general health screening at a younger age,

可以在妇女年轻时 就为她们提供常规检查，

including checkups of blood pressure, body weight and blood sugar.

包括血压、体重和血糖检查。

We could give personalized advice on lifestyle

我们可以就生活方式提供个人化的建议，

and try to influence other risk factors,

并尝试干预其他风险因素，

such as weight gain, obesity,

例如体重增加、肥胖、

smoking or type 2 diabetes.

吸烟或二型糖尿病。

This could be done even before women enter their 50s.

这些甚至可以在女性 50 岁之前完成。

Is this new medical knowledge?

这是新的医学知识吗？

The answer is no.

并不是。

Has this knowledge been acted upon?

这些知识是否已经付诸实践？

Not really.

并没有。

Placenta-related pregnancy complications

与胎盘相关的妊娠并发症

have officially been acknowledged

被正式认作

as sex-specific risk factors for cardiovascular disease

是心血管疾病的性别特异性危险因素，

by the American Heart Association

美国心脏协会

11 years ago,

在 11 年前就对此正式承认。

and other cardiological societies have followed their lead.

其他的心血管协会也相继承认。

Many guidelines suggest or call for follow-up

许多指南建议或要求，

after pregnancy complications.

在妊娠并发症后进行随访。

But we are not aware of any country in the world

但是，我们尚未知道世界上有任何国家

having a systematic cardiovascular follow-up

会对年龄较小、

for women after pregnancy complications

有妊娠并发症后的女性

already at a younger age.

进行系统的心血管随访。

We think such follow-up is of extreme importance

我们认为，这种后续随访，

for equality in health care and society's survival,

对于医疗保健的平等 和社会生存极为重要，

since women are important for society's survival.

因为女性对社会生存至关重要。

We think that it should be possible to integrate

我们认为应该整合出

a simple cardiovascular risk factor assessment --

一个简单的心血管风险因素评估，

measure blood pressure, body weight and blood sugar --

包括测量血压、体重和血糖，

at the general practitioners

这些在常规检查进行的项目。

into existing screening programs for cervical dysplasia

把它们纳入现有的 宫颈发育不良筛查项目，

or other comparable available screening programs around the world.

或世界各地其他的类似筛查项目。

Tomorrow, when you stand in the shower and look at your belly button,

明天，当你淋浴时看着你的肚脐，

remember the placenta.

想想胎盘。

Remember the one simple question

回想一个简单的问题，

that could improve a mother's health.

就可以改善母亲健康状况。

The one simple question that could improve cardiovascular health.

一个简单的问题 就可以改善心血管健康：

Have you had any pregnancy complications?

你有妊娠并发症吗？

(Applause)

（掌声）