Cardiovascular Disease Risk Factors in At-Risk Hispanic Women following Pregnancy Complications

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Pregnancy complications are emerging as important predictors of future cardiovascular health with the demands of pregnancy acting as a “stress test” that reveals a pre-disposition to future cardiovascular disease (CVD) in the mother. Pregnancy may also reveal a predisposition to future depressive disorders, a hypothesis that is consistent with the co-occurrence of, and bi-directional relationship between, depression and CVD, particularly in women. Therefore, the long-term objective of this research is to understand how physical and mental health during pregnancy can help predict CVD events and mental health disorders in later adulthood. The specific objective of the proposed research is to examine the association of pregnancy complications and prenatal mental health with subsequent cardiometabolic profile and mental health in middle adulthood among Hispanics of Puerto Rican heritage living in the continental US. The overarching hypothesis of this proposal is that pregnancy complications will be associated with poorer cardiometabolic health and mental health status in middle adulthood in Puerto Ricans, a Hispanic subgroup at high risk of CVD. Currently, the majority of evidence regarding these associations derives from retrospective cohort studies that linked national birth and death registry databases in Europe. No studies have evaluated these associations in Puerto Ricans despite the fact that this group has the highest prevalence of diabetes, obesity, and major cardiometabolic risk factors among Hispanics and a population growth rate three times higher than the general US population. The proposed study provides a unique opportunity to leverage our previously-collected prospective pregnancy data from Proyecto Buena Salud (PBS, R01 DK064902, PI: Chasan-Taber). PBS was a prospective study of Puerto Rican women conducted from 2006-2011 that provided novel evidence that pregnancy complications and prenatal depression were highly prevalent in Puerto Ricans and were significantly associated with adverse maternal and birth outcomes. It has now been an average of 13.4 years since the participants’ PBS pregnancy. Our feasibility study projects that 87% (n=1,096) of PBS participants will participate in our proposed follow-up study. For the proposed study, bilingual/bicultural staff will conduct in- person visits to collect biomarkers of insulin resistance, inflammation, lipids, adiposity, blood pressure, and chronic physiological stress (hair cortisol concentrations). Interviewer-administered questionnaires, validated in Hispanics, will measure depression, psychosocial stress, and anxiety. We will use actigraphy to evaluate the novel hypothesis that poor sleep and low physical activity, highly prevalent among Puerto Ricans, may mediate the above relationships. This research is significant in prospectively assessing whether pregnancy complications offer a meaningful opportunity for early CVD prevention efforts. This research also has translational significance in informing culturally sensitive prenatal interventions for early life prevention of future chronic disorders in an understudied and particularly vulnerable population.