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Introduction Cardiovascular risk factors in midlife have been linked to late life risk for Alzheimer's disease and related dementias (ADRD). The relation of vascular risk factors on cognitive decline within midlife has been less studied. Methods Using data from the Study of Women's Health Across the Nation, we examined associations of midlife hypertension, elevated lipid levels, diabetes, fasting glucose, central adiposity, and Framingham heart age with rates of cognitive decline in women who completed multiple cognitive assessments of processing speed, and working and verbal memory during midlife. Results Diabetes, elevated fasting glucose, central obesity, and heart age greater than chronological age were associated with rate of decline in processing speed during midlife. Vascular risk factors were not related to rate of decline in working or verbal memory. Discussion Midlife may be a critical period for intervening on cardiovascular risk factors to prevent or delay later life cognitive impairment and ADRD.

Background: Excessive weight gain during pregnancy is common and has been shown to be associated with increased long-term maternal weight. However, less is known on whether there is a cumulative effect of excessive gestational weight gain (GWG) over multiple pregnancies. Methods: Data from the Study of Women's Health Across the Nation were used, restricted to parous women with no history of stillbirth or premature birth. The effect of the number of excessive GWG pregnancies on body mass index (BMI) in midlife (age 42–53) was analyzed using multivariable linear regression. Fully adjusted models included parity, inadequate GWG, demographic, and behavioral characteristics. Results: The 1181 women included in this analysis reported a total of 2693 births. Overall, 466 (39.5%) were categorized as having at least one pregnancy with excessive GWG. The median BMI at midlife was 26.0 kg/m(2) (interquartile range 22.5–31.1). In fully adjusted models, each additional pregnancy with excessive GWG was associated with 0.021 higher estimated log BMI (p = 0.031). Among women with 1–3 births, adjusted mean (95% confidence interval) BMI for those with 0, 1, 2, and 3 excessive GWG pregnancies was 25.4 (24.9–25.9), 26.8 (26.1–27.5), 27.5 (26.6–28.4), and 28.8 (27.3–30.5), respectively. Conclusions: In this multiethnic study of women with a history of term live births, the number of pregnancies with excessive GWG was associated with increased maternal BMI in midlife. Our findings suggest that prevention of excessive GWG at any point in a woman's reproductive history can have an impact on long-term maternal health.

The ability of latent class models to identify clinically distinct groups among high-risk patients has been demonstrated, but it is unclear how healthcare data can inform group-specific intervention design. Examine how utilization patterns across latent groups of high-risk patients provide actionable information to guide group-specific intervention design. Cohort study using data from 2012 to 2015. Participants were 934,787 patients receiving primary care in the Veterans Health Administration, with predicted probability of 12-month hospitalization in the top 10th percentile during 2014. Patients were assigned to latent groups via mixture-item response theory models based on 28 chronic conditions. We modeled odds of all-cause mortality, hospitalizations, and 30-day re-hospitalizations by group membership. Detailed outpatient and inpatient utilization patterns were compared between groups. A total of 764,257 (81.8%) of patients were matched with a comorbidity group. Groups were characterized by substance use disorders (14.0% of patients assigned), cardiometabolic conditions (25.7%), mental health conditions (17.6%), pain/arthritis (19.1%), cancer (15.3%), and liver disease (8.3%). One-year mortality ranged from 2.7% in the Mental Health group to 14.9% in the Cancer group, compared to 8.5% overall. In adjusted models, group assignment predicted significantly different odds of each outcome. Groups differed in their utilization of multiple types of care. For example, patients in the Pain group had the highest utilization of in-person primary care, with a mean (SD) of 5.3 (5.0) visits in the year of follow-up, while the Substance Use Disorder group had the lowest, with 3.9 (4.1) visits. The Substance Use Disorder group also had the highest rates of using services for housing instability (25.1%), followed by the Liver group (10.1%). Latent groups of high-risk patients had distinct hospitalization and utilization profiles, despite having comparable levels of predicted baseline risk. Utilization profiles pointed towards system-specific care needs that could inform tailored interventions.

Background Lifecourse research provides an important framework for chronic disease epidemiology. However, data collection to observe health characteristics over long periods is vulnerable to systematic error and statistical bias. We present a multiple-bias analysis using real-world data to estimate associations between excessive gestational weight gain and mid-life obesity, accounting for confounding, selection, and misclassification biases. Methods Participants were from the multiethnic Study of Women's Health Across the Nation. Obesity was defined by waist circumference measured in 1996-1997 when women were age 42-53. Gestational weight gain was measured retrospectively by self-recall and was missing for over 40% of participants. We estimated relative risk (RR) and 95% confidence intervals (CI) of obesity at mid-life for presence versus absence of excessive gestational weight gain in any pregnancy. We imputed missing data via multiple imputation and used weighted regression to account for misclassification. Results Among the 2,339 women in this analysis, 937 (40%) experienced obesity in mid-life. In complete case analysis, women with excessive gestational weight gain had an estimated 39% greater risk of obesity (RR = 1.4, CI = 1.1, 1.7), covariate-adjusted. Imputing data, then weighting estimates at the guidepost values of sensitivity = 80% and specificity = 75%, increased the RR (95% CI) for obesity to 2.3 (2.0, 2.6). Only models assuming a 20-point difference in specificity between those with and without obesity decreased the RR. Conclusions The inference of a positive association between excessive gestational weight gain and mid-life obesity is robust to methods accounting for selection and misclassification bias.

Introduction: Excessive gestational weight gain (GWG) is associated with long-term increased risk of maternal obesity. However, the literature on whether excessive GWG contributes to an adverse cardiovascular risk profile is minimal and conflicting. Hypothesis: We hypothesized that a history of excessive GWG would be associated with maternal cardiovascular risk factors representing inflammation, glucose dysregulation, and dyslipidemia at midlife among parous women. Methods: This analysis included 1351 participants in the multiethnic cohort Study of Women’s Health Across the Nation with one or more live, singleton births. Excessive GWG in past pregnancies was determined by self-report of prepregnancy weight and GWG, and defined according to Institute of Medicine guidelines. Outcomes were CRP, LDL-C, HDL-C, fasting glucose, diabetes, blood pressure, and medication use, dichotomized based on 2019 ACC/AHA clinical guidelines as applicable. Outcomes were assessed at the baseline visit when women were age 42 to 53. We estimated relative risk between ever-having excessive GWG and each outcome in separate generalized linear regressions. Multivariable models adjusted for demographic, behavioral, and reproductive characteristics including parity and pregnancy complications. Results: Of the 1351 participants, 554 (41.0%) experienced excessive GWG. In unadjusted models, excessive GWG was associated with increased relative risk of high CRP, hypertension, low HDL-C, high glucose, and diabetes at midlife, but not high LDL-C (see Table). After adjusting for confounders, only risk of high CRP (RR= 1.34; 95% CI= 1.17, 1.54) and diabetes (RR=2.62; 95% CI=1.14, 5.98) remained statistically significant. Conclusions: A history of excessive GWG was linked with an increased risk of inflammation and diabetes but not dyslipidemia, hypertension, or high glucose in parous midlife women, independent of parity, pregnancy complications, and other factors. Table. Risk Ratios of Cardiovascular Risk Factors by Excessive GWG