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.
