Abstract Body (Do not enter title and authors here): Background: Women with a history of adverse pregnancy outcomes (APOs) have an increased risk for heart disease and stroke; however, data on risk for peripheral arterial disease (PAD) are scarce.

Hypothesis: We hypothesized that women with a history of an APO were at greater risk for incident PAD.

Methods: Data from the Women’s Health Initiative, which enrolled 161,808 postmenopausal women, aged 50-79 years, between 1993 and 1998, were used for the present analysis. Participants who completed survey items in 2017 on APO history were eligible for this study. Incident PAD was defined as ≥ one of the following in a lower extremity artery: stenosis or ulceration (≥50% diameter or ≥75% cross-sectional area) on imaging; absence of arterial pulse by Doppler; claudication on exercise testing; surgery, angioplasty or thrombolysis for PAD; amputation of or part of the lower extremity due to ischemia or gangrene; physician diagnosed claudication; or an ankle-brachial index (ABI) of ≤ 0.8. Events were adjudicated from baseline to 2010. Participants were eligible for this analysis if they did not have a history of PAD at baseline, had ≥1 pregnancy lasting >6 months, and had non-missing data on APOs (n=47,370). Multivariable models examined the association between APOs and incident PAD, adjusting for age, race/ethnicity, education, income, physical activity, diet, sleep, and alcohol intake.

Results: A history of APOs was reported by 13,666 women (28.8%), with 8,325 reporting one APO and 5,341 reporting two or more APOs. The most common APO reported was pre-term delivery (6,910 [14.6%]), followed by low birth weight (5,866 [12.4%]). Women who reported at least one APO had higher odds for incident PAD (adjusted odds ratio [aOR] 2.02, 95% confidence interval [CI] 1.43-2.85) compared to women without an APO. Individual APOs including gestational hypertension/preeclampsia (aOR 2.31, 95% CI 1.35-3.95), low birth weight (aOR 2.50, 95% CI 1.71-3.66), and preterm delivery (aOR 1.71, 95% CI 1.15-2.56) were associated with incident PAD, while gestational diabetes demonstrated a higher, but nonsignificant, odds for PAD (aOR 1.87, 95% CI 0.68-5.12).

Conclusion: In this large cohort of multiethnic women, APOs were associated with a doubled risk for incident PAD. Gestational hypertension/preeclampsia, low birth weight, and preterm delivery were independently associated with incident PAD. Additional research is warranted to understand the underlying mechanisms linking APOs and PAD.