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.
