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. .