The impact of adolescent reproductive health on risk for cardiometabolic disease in young adult women

Project Summary Sex differences in cardiometabolic health are driving the call for research focusing on women. Compared with men, women are more vulnerable to cardiometabolic disease, including hypertensive disorders, heart disease, cerebrovascular incidents, and diabetes. Reproductive health factors appear to partially explain the observed sex differences in cardiometabolic health. Although most research to date has been conducted in adult women and has tested associations between reproductive health and overt disease, this research framework can be leveraged for testing hypotheses relevant for preventive interventions. The aim of the present application is to test the relative utility of multiple measures of adolescent reproductive health for predicting risk of cardiometabolic disease in early adulthood. We will use data from The Pittsburgh Girls Study, a longitudinal community-based study that included annual interviews of girls and their caregivers beginning in childhood. We focus on three domains of reproductive health: pubertal (timing and tempo, age at menarche, menstrual cycle regularity), sexual (use of hormonal contraception, HPV vaccination, sexually transmitted infection), and pregnancy health (age at first pregnancy, parity, experiences of miscarriage and preterm birth). These data will be linked to biomarkers of cardiometabolic health in early adulthood (ages 21-24) including waist circumference, fasting serum blood sugars and lipids, and markers of systemic inflammation including TNF-alpha, IL-6, and CRP. Further, we propose to test how patterns in severity, timing, and chronicity of stress exposure, which we have derived from PGS data, impact the association between adolescent reproductive health and risk for cardiometabolic disease. We focus on specific domains of stress exposure: subsistence (e.g., resource strain, overcrowding), safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression). We will specify the role of stress exposure on the association between adolescent reproductive health and risk of cardiometabolic disease for different subgroups of women. Our specific aims are to 1: Test the relative utility of multiple indicators of reproductive health for predicting risk of cardiometabolic disease in early adulthood, and 2: Test the impact of stress exposure in childhood and adolescence on the association between reproductive health and risk for cardiometabolic disease. We hypothesize that domains of reproductive health will impact cardiometabolic risk differentially for different subgroups of women, and that moderated models for the associations among stress exposure, reproductive health, and risk for cardiometabolic disease will be differentially specified for different subgroups of women.