INTRODUCTION:
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among individuals in the United States (US).1 Older age, obesity, smoking, use of opioids2, prior CVD, diabetes, high blood pressure, thromboembolism, and previous adverse pregnancy outcomes (APOs) are risk factors for CVD. Racism and inequities contribute to disparities in birth outcomes and CVD across an individual’s life course.3 In addition, chronic stress, a measure of cumulative wear and tear on the body’s adaptive system, can be estimated by allostatic load (AL) and has been associated with increased odds of CVD.4
Pregnancy has been described as a window into future maternal health because of the significant anatomical, physiological changes during pregnancy and the association between adverse pregnancy outcomes and subsequent CVD. 5, 7 Chronic stress and allostatic load have been associated with adverse pregnancy outcomes.8, 9 However, the relationship between chronic stress during pregnancy and subsequent CVD has not been assessed.
Significant racial disparities exist in CVD events among pregnant individuals, and data on racial disparities in CVD outcomes after pregnancy are limited. Chronic stress may, in part, explain racial disparities noted in CVD, with higher rates noted in non-Hispanic Black individuals. 4 Compared to non-Hispanic White individuals, non-Hispanic Black individuals have a higher risk of mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy. 10
We aimed to assess the relationship between allostatic load and CVD-related outcomes. We hypothesize that allostatic load measured in early pregnancy is associated with subsequent maternal CVD-related outcomes. Secondarily, we hypothesize that allostatic load during pregnancy may be a pathway that contributes to racial disparities in subsequent CVD-related outcomes. .