PROJECT SUMMARY / ABSTRACT
Poor maternal cardiovascular health (CVH: behaviors + factors) in the peri-pregnancy period contributes to poor
offspring CVH over the life course, especially in socially disadvantaged groups. Many interventions have targeted
maternal CVH behaviors during pregnancy, but to improve offspring outcomes, targeting maternal CVH during
preconception may be more effective due to critical early gestational events. However, preconception maternal
CVH is understudied because half of pregnancies are unplanned, and clinical care among individuals of
childbearing age is inconsistent. Pediatric clinical settings offer a novel access point for maternal preconception
CVH, since >60% of births annually are to mothers who already have children. Leveraging this access to inves-
tigate key timing and drivers of maternal-child CVH across the entire peri-pregnancy period (preconception,
pregnancy, and postpartum) could reveal opportunities to break intergenerational cycles of cardiovascular dis-
ease and related disparities. Our long-term goal is to develop strategies that optimize CVH from the beginning
of life. Our objective here is to characterize key timing and drivers of maternal-child CVH across peri-pregnancy
to inform future person-centered interventions. We will leverage our Young Hearts study of diverse children from
clinics across Chicago to enroll and follow mothers who are likely to have another pregnancy, as well as fa-
thers/co-parents and subsequent offspring, and study them from preconception through postpartum. Based on
our preliminary data, we hypothesize that 1) preconception is a sensitive period for the impact of maternal CVH
on offspring CVH, 2) specific social and psychological factors shape maternal capacity, opportunity, and motiva-
tion for healthy lifestyle and CVH, and 3) parents and clinicians desire specific intervention strategies to optimize
maternal and child CVH. We will test our hypothesis via three specific aims: 1) Compare the contributions of
preconception, pregnancy, and postpartum maternal CVH to child outcomes; 2) Map the contributions of social
and psychological factors to maternal CVH; and 3) Determine parents’ and clinicians’ preferences for intervention
characteristics to optimize maternal-child CVH. We will analyze data from online surveys and electronic medical
records among ~650 families to address Aims 1 and 2, and we will interview ~40 mothers (twice), 20 fathers/co-
parents, and 30 clinicians to address Aims 2 and 3. We will then integrate quantitative and qualitative findings
into a theory-based logic model for change and guiding principles for intervention. Key innovations are a novel
approach to access preconception, pragmatic technology-enabled cohort design, and integration of health psy-
chology theory and person-centeredness in a refined mixed-methods approach. The outcomes of this research
on when to intervene, what to intervene on, and how to intervene will help direct public health resources and will
provide a strong evidence base to develop novel interventions that promote optimal maternal-child CVH in di-
verse psychosocial contexts. The proposed project will thus enable significant progress toward eliminating ma-
ternal-child health disparities and launching future generations of children with optimal CVH.
