ABSTRACT In the United States, cardiovascular disease (CVD) is the leading cause of mortality in women, and the prevalence of cardiometabolic risk factors and cardiometabolic-related pregnancy complications are greater in Black and underrepresented women than White women. Race is a social construct and not biological, thus ethnicity/race alone cannot explain the disparities in cardiometabolic complications in pregnancy. These inequalities in cardiometabolic diseases during pregnancy may be explained in part by structural racism, which includes neighborhood environment and residential segregation. Yet, studies on structural racism and CVD risk are limited, particularly in pregnancy and the postpartum period. Therefore, the objective of this proposal is to understand whether structural racism is associated with CVD risk during pregnancy and postpartum among women and infants. This proposal supplements the Mother and Infant Determinants of vascular Aging Study (MIDAS; R01HL157075). The MIDAS study will enroll 840 racially/ethnically diverse healthy and medically complicated mother/infant dyads between 34-40 weeks’ gestation. At 34-40 weeks’ gestation, within 48 hours of delivery, and at 6 and 12 months postpartum, the MIDAS study will assess CVD risk by measuring pulse wave velocity (PWV), and examine relationships among biologic, personal, social, and ecological disease risk factors with PWV. Although neighborhood was a proposed CVD risk factor in the parent grant, this proposal will complement the existing MIDAS study by adding structural racism data and in-depth analysis of these data and CVD risk among women and infants. The study specific aims are to: 1) examine the association between structural racism and maternal arterial stiffness at the 3rd trimester in pregnancy and the trajectory to 1 year postpartum, and 2) determine the association between structural racism and infant arterial stiffness at 6 months and its change to 12 months. This time sensitive supplement leverages access to a large, diverse cohort of pregnant and postpartum women and their infants, and a multi-disciplinary team of mentors with expertise in CVD risk, maternal health, and racial health disparities. As a result, we are well positioned to complete the proposed aims. Additionally, this supplement will enable an early career investigator to: 1) gain experience conducting a well-defined research project evaluating CVD risk in pregnant women and their infants, 2) develop her knowledge on pregnancy-related cardiometabolic biomarkers and macro level risk factors (neighborhood and community-level), 3) further skills in statistical analysis and grantsmanship, and 4) expand her research network and learn from a successful mentorship team. This supplement will be an integral component to the MIDAS study by focusing on structural racism-related risk to maternal and infant cardiovascular health and it will provide an early career investigator with support to advance her career trajectory and establish an independent, fundable research line.

PROJECT NARRATIVE In pregnant and postpartum women, there is a lack of data addressing biological, social, personal and ecological cardiovascular disease risk factors. Structural racism, which includes neighborhood environment and residential segregation, may contribute to race/ethnic inequalities in cardiometabolic diseases during and after pregnancy. This supplement will leverage the Mother and Infant Determinants of vascular Aging Study (MIDAS; R01HL157075), which will enroll a diverse cohort of mothers with healthy and complicated pregnancies, to determine whether structural racism is associated with pregnancy and postpartum cardiovascular disease risk among women and infants.