ABSTRACT Pre-eclampsia is one of the most common complications of pregnancy and is associated with increased morbidity and mortality for the infant and mother with the potential for long term implications. Health disparities in incidence and outcomes of pre-eclampsia have been reported by some studies, further complicating the condition. South Carolina (SC) has a large minority population (27.9% African-American; 5.3% Hispanic), and more than 2/3 of resident births are among black women and other races/ethnicities. Although some evidence exists related to poor maternal and infant complications of pre-eclampsia, potential racial differences in pre- eclampsia associated morbidity and mortality have not been examined. SC provides a unique opportunity to study racial differences, which is critical in terms of the risk, clinical course, and outcomes of pre-eclampsia. The proposed project will be accomplished through two specific aims: (1) To determine the impact of pre- eclampsia on long term maternal risk of cardiovascular disease at 1, 3, 5, and 10-years at the population level in SC and to examine potential differences by race; and (2) To determine the impact of pre-eclampsia on risk of poor birth and long term offspring outcomes at birth, 1, 3, 5, and 10-years at the population level in SC and to examine potential differences by race. A retrospective cohort study will be conducted to investigate pre- eclampsia as a risk factor for poor and long term maternal and infant outcomes using existing statewide data for all live births that has been linked to birth certificates, maternal inpatient hospital discharge and emergency department visit encounters, and mortality over a 13-year period (2004-2016). Dr. Malek is an epidemiologist in the Department of Public Health Sciences at the Medical University of South Carolina. Her long-term career development goal is to become an independent investigator whose research will contribute to improved health for women, infants, and children; specifically through reduction of risk factors for poor infant as well as long term offspring and maternal clinical outcomes. To help facilitate her transition into an independently funded scientist, Dr. Malek will receive training in perinatal epidemiology, health disparities, and big data analysis. The environment involves a multidisciplinary research team of epidemiologists (perinatal and cardiovascular), a bioinformatician, and clinicians (obstetrics/gynecology, neonatology, and stroke neurology) invested in Dr. Malek’s career development and success with a proven track record in mentorship, to ensure successful completion of the proposed project. Moreover, preliminary results from this study will be used for preparation of an NIH R01 grant proposal to facilitate enrolling a prospective cohort of women to obtain better data in terms of pre-eclampsia risk factors, biological samples and physiologic measures, environmental risk factors, and short and long term clinical outcomes for mothers with pre-eclampsia and their children.

PROJECT NARRATIVE This project will evaluate long term maternal and infant complications in pre-eclampsia with a focus on health disparities. Better understanding the impact of pre-eclampsia on long term clinical outcomes, such as cardiovascular disease in mothers and developmental disabilities in children, could lead to clinical practice and public health prevention efforts for at-risk populations.