Preconception and prenatal stress effects on cardiovascular disease risk in black women

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PROJECT SUMMARY Cardiovascular disease (CVD) is a leading cause of mortality and morbidity and disproportionately affects Black American women. Compelling evidence highlights pregnancy as an important window for identifying future CVD risk. Although Black women are also at elevated risk for cardiovascular complications during pregnancy, heterogeneity is poorly understood and differentiated phenotypes of CVD risk before, during and after pregnancy are lacking. Consistent with models of racial stress, Black women are often exposed to contextual stressors (e.g., discrimination stress, adversity, violence) over the lifespan that contribute to racial disparities in health via alterations in stress regulation systems. Prenatal stress reactivity has been linked to poor obstetric health and adverse birth outcomes, but the effects of on women’s cardiovascular morbidity in the postpartum period are unclear. In response to RFA-MD-20-800 ‘Addressing Racial Disparities in Maternal Mortality and Morbidity’, the proposed research examines individual differences in prenatal stress regulation as a biological pathway through which early and chronic stress exposure impacts postpartum CVD risk among Black women. The study also builds on growing evidence shows that dietary polyunsaturated fatty acids (PUFAs) are associated with reduced stress reactivity and CVD risk, and our own work with Black women supports their utility as a modifiable target for intervention during pregnancy. Thus, we will explore the protective effects of prenatal PUFA levels on the association between lifetime stress and postpartum CVD risk. The Pittsburgh Girls Study (PGS), a 20-year longitudinal study that began annual assessments of stress exposures in childhood, provides an unprecedented opportunity to elucidate phenotypes of peripartum CVD risk as a function of lifetime stress. We propose to recruit Black pregnant women (N = 400) from the PGS and collect biobehavioral measures of CVD risk (i.e., lipids, blood sugar, blood pressure, adiposity, diet, smoking and activity) and inflammatory markers at 2, 12 and 24 months postpartum. These new data will be linked to extant PGS data on preconception and prenatal CVD biobehavioral markers, lifetime stress exposures, and prenatal stress regulation to address the following Specific Aims among Black women: (1) Elucidate peripartum phenotypes of CVD risk related to life stress; (2) Examine the impact of prenatal stress regulation on postpartum CVD risk; and (3) Explore the moderating effects of prenatal PUFAs on CVD risk. The proposed longitudinal study builds on the prior work of the multidisciplinary investigative team and will provide the first rigorous examination of peripartum phenotypes of CVD risk among Black women. Achieving the stated aims will inform causal models of risk and generate critical knowledge for optimizing the timing of, and novel targets for, interventions to reduce persistent racial disparities in maternal cardiovascular morbidity.