Associations of Pregnancy History and Complications with Incident Cardiovascular Disease Among American Indian Women: The Strong Heart Family Study

In the United States, cardiovascular disease is a leading cause of death among American Indian women. We examined the associations of parity (0/1, 2-4, >=5) and pregnancy complications (history of preeclampsia, protein in urine; eclampsia or seizures; gestational diabetes, hypertension) with incident cardiovascular disease (myocardial infarction, coronary heart disease, congestive heart failure, ischemic stroke) among American Indian women in the Strong Heart Family Study. Baseline information was collected between January 2006 and December 2009. Cardiovascular disease events were evaluated through December 2022. We used clustered logistic regression analyses to assess these associations among women free of cardiovascular disease at baseline (N=1,203). American Indian women with >=5 parity (grand multiparous) represented 25.5% of the sample size. Grand multiparous participants were 33% more likely to develop cardiovascular disease when compared to those with 0/1 parity (OR=1.33, 95% CI: 0.65, 2.71; p=0.44). Participants with pregnancy complications were 8% more likely to develop cardiovascular disease when compared to women with no pregnancy complications (OR=1.08, 95% CI: 0.62, 1.88; p=0.78). While the findings were not statistically significant, they support potential positive associations of grand multiparity and pregnancy complications with cardiovascular disease in American Indian women. This work suggests that American Indian women with grand multiparity and/or pregnancy complications should be followed closely and screened for cardiovascular disease.