The impact of structural racism during pregnancy on future cardiopulmonary health

Cardiovascular disease (CVD) is the leading cause of death in women in the United States. Mounting evidence suggests that pregnancy is a key window when cardiovascular (CV) health is eroded, increasing future CVD risk. Further, the link between CV and lung health is well-established, and the critical prenatal period may influence multiple future morbidities simultaneously. Neighborhood-level factors may result in a pro-inflammatory state during pregnancy and impair postpartum cardiopulmonary health (CV and lung health) setting the stage for future chronic disease risk. For instance, evidence from our pregnancy cohort (Generation C) in NYC found that neighborhood measures were associated with preterm birth which separately has been linked to a life course two-fold risk of CVD and respiratory mortality. To better understand the effect of neighborhood during pregnancy on future cardiopulmonary health, we propose Gen C Mamas, a mixed-method longitudinal study of 440 women from the Generation C cohort, initially recruited during pregnancy in 2020-2022 in New York City. We will use the life course model of multimorbidity, resilience, and weathering in our proposed Gen C Mamas study. First, we will assess the association between neighborhood and cardiopulmonary health (e.g., systolic and diastolic blood pressure, lung function, and hemoglobin A1c) at 3 and 5 years postpartum. Then we will leverage previously collected data to examine how mid-pregnancy inflammation is associated with neighborhood factors during pregnancy and cardiopulmonary health. Finally, we will select 30 participants from this subgroup and invite them to participate in Photovoice data collection. We will hold focus group sessions where participants will narrate the stories of their photo choices, and these stories will be analyzed for themes and then mapped to our theoretical framework. Because of the central role of inflammation in health, our findings may provide a model that can be extended to additional chronic conditions.