Abstract Body: Background: Adverse pregnancy outcomes (APOs) have been linked to increased cardiovascular risks, but longitudinal studies in diverse U.S. populations are limited.

Objective: To investigate the association between APOs and the timing and incidence of cardiovascular events in a large, diverse cohort.

Methods: We analyzed longitudinal data from the All of Us Research Program focusing on adverse pregnancy outcomes (APOs) as the exposure. The primary outcome was a composite of cardiovascular events including ischemic stroke, intracerebral hemorrhage (ICH), heart failure (HF), and myocardial infarction (MI). We assessed the incidence and age at onset of these cardiovascular events, comparing women with and without APOs. Adjusted hazard ratios (HRs) were estimated using Cox multiple regression models to analyze the impact of APOs on the risk of cardiovascular events. We used linear regression to examine the relationship between adverse pregnancy outcomes (APOs) and age at cardiovascular events, including interaction and stratified analyses by race/ethnicity.

Results: In All of Us, out of a total of 414,570 participants, we found 10,602 parous women, mean age at birth was 29.63 (6.59). Five thousand, six hundred twenty (54%) had at least one APO, including 1,089 (10.5%) who experienced preeclampsia-eclampsia, 1,044 (10.0%) gestational hypertension, 1,146 (11.0%) gestational diabetes, 637 (6.1%) fetal growth restriction, 612 (5.9%) experienced placental abruption, and 1,092 (10.5%) had preterm births. Women with APOs had a significantly increased risk of composite adverse cardiovascular outcomes (adjusted HR: 1.45; 95%CI:11.13-1.85) and specific events such as ischemic stroke (adjusted HR: 1.51; 95%CI:1.03-2.22) and heart failure (adjusted HR: 1.34; 95%CI:1.03-1.89). Additionally, APOs were linked to a younger age at cardiovascular events, with significant variations by race/ethnicity(interaction p<0.05). Black participants with APOs had a younger age at cardiovascular outcome (β -3.99; p<0.001), as did Hispanic participants (β -3.31; p=0.03). This association was not significant in White participants after adjustment.

Conclusions: APOs are associated with an increased risk and earlier onset of cardiovascular events among a representative and diverse cohort of American parous women.