AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Race and Ethnicity Differences in ASCVD Risk After Adverse Pregnancy Outcomes
By Das R, Boinpally N, Barzallo Zaes D et al.
Background: Adverse pregnancy outcomes have been linked to higher long-term cardiovascular risk. Prior studies have examined this relationship across race/ethnicity groups, but evidence remains difficult to compare across cohorts, outcome definitions, and pregnancy complication types. We examined EHR-recorded adverse pregnancy outcomes and incident ASCVD in a pregnancy-evidence cohort from the All of Us Research Program, focusing on race/ethnicity and two common APO subtypes: hypertensive disorders of pregnancy and gestational diabetes. Methods: We analyzed women in the All of Us Research Program with EHR evidence of pregnancy-related care, age 18-50 at pregnancy index, at least 365 days of prior EHR observation, and no ASCVD before index. The pregnancy index was based on a recorded delivery date when available and otherwise assigned from pregnancy-related EHR records. APOs were identified in a pregnancy-associated window and included hypertensive disorders of pregnancy, preeclampsia/eclampsia, and gestational diabetes. Incident ASCVD was defined as myocardial infarction, ischemic stroke, PCI, or CABG after index. Cox models adjusted for age and race/ethnicity estimated APO-associated ASCVD risk, with interaction models evaluating whether associations differed by race/ethnicity and APO subtype. Results: Among 36,958 women in the non-Hispanic White, non-Hispanic Black, and Hispanic/Latina groups, 1,108 incident ASCVD events occurred. APO history was associated with higher incident ASCVD risk after adjustment for age and race/ethnicity: HR 1.52, 95% CI 1.18-1.95. This association differed by race/ethnicity. Compared with non-Hispanic White women, non-Hispanic Black women had a stronger APO-associated hazard: interaction HR 1.34, 95% CI 1.05-1.71; p=0.017. No similar interaction was seen for Hispanic/Latina women. In subtype analyses, the signal was driven mainly by hypertensive disorders of pregnancy: HR 1.65, 95% CI 1.27-2.14. Gestational diabetes showed no clear association with ASCVD. The HDP-associated hazard was also stronger among non-Hispanic Black than non-Hispanic White women: interaction HR 1.35, 95% CI 1.05-1.75; p=0.020. Conclusion: In this pregnancy-evidence cohort, EHR-recorded APOs were associated with higher incident ASCVD risk. The association was stronger among non-Hispanic Black than non-Hispanic White women and was driven mainly by hypertensive disorders of pregnancy rather than gestational diabetes. These findings point to closer cardiovascular follow-up after hypertensive pregnancy complications, particularly among non-Hispanic Black women.