Accumulation of stress and trauma across the life course and cardiometabolic risk during pregnancy and postpartum

项目摘要

Project Abstract In the United States, at least 1 in 10 pregnant people experience a cardiometabolic disorder of pregnancy each year such as a hypertensive disorder of pregnancy (HDP; 6-8%) or gestational diabetes (GDM; 2-10%). Either diagnosis is associated with increased risk of maternal morbidity and mortality, poor infant outcomes, and long term increased risk of cardiometabolic disease. Non-Hispanic Black and low-income women face a higher risk of cardiometabolic disease during and following pregnancy compared to non-Hispanic white or higher income women. Only part of this difference can be explained by medical risk factors or access to care. Theory and limited evidence suggest that experiences of stress and trauma, including from racism across the life course, increase the risk of adverse pregnancy outcomes and cardiometabolic disease in later life. However, evidence is limited, particularly during pregnancy and postpartum. Thus, the overarching goal of this study is to understand how stressful and traumatic experiences across the life course are embodied in women’s cardiometabolic health during and following pregnancy. To do this, I will use data from two existing cohorts, the Grady Trauma Project, based in Atlanta, and CARDIA, and prospectively collect data from pregnant and postpartum women within the EmPOWR data registry, based in Atlanta. The specific aims of this project are to: (1) Estimate the direct and indirect effects of lifetime trauma on cardiometabolic disorders of pregnancy (HDP and GDM). (2) Estimate the effect of risky childhood family environment on (a) incident gestational diabetes (b) changes in cardiometabolic function following childbearing. (3) (a) Describe trajectories of cumulative life stress and (b) estimate the effect of distinct cumulative life stress patterns prior to pregnancy on postpartum weight loss. (4) Estimate the effect of cumulative life stress prior to pregnancy on lactation and sleep duration postpartum. The primary training experience will be to develop expertise in the measurement and analysis of early indicators of cardiometabolic dysfunction in women and the modeling of changes in metabolic biomarkers over time during both the K99 and R00 phases. The research and training will be supported by an interdisciplinary mentorship team led by Dr. Shakira Suglia and comprised of experts in epidemiology, obstetrics, and life course theory. The results from these aims will expand our understanding of women’s trajectories of cardiometabolic health and its relationship with cumulative stress across the life course and may expand options for novel prevention strategies in the preconception, prenatal, and postpartum periods.