Hypertensive Disorders of Pregnancy and Early Risk of Maternal CVD: Influence of the External Exposome

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PROJECT SUMMARY Hypertensive disorders of pregnancy (HDP) are the most common pregnancy complication and are associated with an increased long-term risk of cardiovascular disease (CVD) which is also the leading cause of death for women in the US. Emerging evidence suggests that environmental exposure during pregnancy may play an important role in the development of HDP. However, several limitations exist, including 1) the ignorance of residential mobility during pregnancy in exposure assessments, 2) the lack of studies considering different subtype, onset, and severity of HDP, and 3) the lack of considerations of the totality of environment (i.e. the exposome). While HDP have been linked to long-term CVD risk after pregnancy, limited data are available on early maternal CVD risk (within the first five years after delivery) complicated by HDP. More importantly, no study has focused on the impact of environmental exposures during and after pregnancy on maternal CVD risk after pregnancy. In addition, risk assessment models of HDP predominantly rely on biomarkers that are not ubiquitously tested among all pregnant women, and no predictive model has been developed to identify women at higher CVD risk after pregnancy. This study builds on our prior work in the external exposome and leverages our access to the unique statewide linked electronic health records-birth records data from the OneFlorida Clinical Research Consortium to address multiple challenges in the field by: 1) determining the association between pregnancy external exposome and risk of HDP, considering the subtype, onset, and severity of HDP and accounting for pregnancy residential mobility in exposure measurements; 2) assessing early risk of maternal CVD after pregnancy associated with HDP and the external exposome, and 3) developing predictive models of HDP and early risk of maternal CVD after pregnancy. This research project will be embedded in a comprehensive training program consisting of coursework, guided experiential and clinical learning, seminars, and mentorship by an established team of experts. The training program is designed to further my strengths and to develop new research skills while contributing to our scientific understanding of environmental impacts on cardiovascular health among pregnant and postpartum women. The training proposal details a five-year plan of formal and informal instruction in cardiovascular health, omics and exposome research, biomedical informatics and data science, and professional skills. My short-term career goals include completing coursework in all training areas, disseminating study findings through publications and presentations, engaging in career development activities, and applying for independent R01 funding in the third year of the award. My long-term career goal is to become an independent, collaborative, and productive epidemiologist and health data scientist leading research programs in cardiovascular health, with a focus on its intersection with perinatal and environmental epidemiology using big data.