Advisor(s)

Kelley Gabriel

Committee Member(s)

Candace Knight
Erin Dooley
Fazlur Rahman
Shakia Hardy

Document Type

Dissertation

Date of Award

6-1-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Public Health

Department

Epidemiology

Abstract

More than 40% of U.S. women have cardiovascular disease (CVD), and nearly half have at least one major risk factor. Sparse evidence exists related to the role of childrearing (regardless of prior pregnancy) on CVD. A recent literature review highlighted the influence of reproduction on CVD and health and identified opportunities for advancement. At present, it has yet to be discovered from prospective epidemiologic studies the extent to which parenting and maternal events have influence on cardiovascular health and clinical events. It has been demonstrated that parous women have greater prevalence of cardiovascular risk factors (e.g., short sleep duration and poor diet), compared to nulliparous women. Additionally, studies which examined associations of major life events with physical activity suggest declines related to changes in family structure and physicality. Missing from these studies are 1) broader definitions of motherhood, 2) extended observation periods for surveillance of cardiovascular clinical events and health behaviors, and 3) repeated measures of physical activity. This dissertation fills these critical gaps to have a more complete understanding of maternity and its roles in association with cardiovascular health and outcomes. The overarching hypothesis was that maternal roles and related events would convey differences in health behaviors (leading to poor cardiovascular health) and subsequent risk of clinical outcomes (i.e., premature death and fatal/non-fatal CVD) using a life-course perspective. This hypothesis was tested using extant data from Coronary Artery Risk Development in Young Adults (CARDIA), a multicenter longitudinal study of Black and White men and women aged 18-30 years at baseline (1985-86). In women, we first observed that biological motherhood factors (including history of gestational diabetes, age of motherhood onset, and cumulative motherhood years) were significantly associated with cardiovascular health. Second, we found biological motherhood (versus non-motherhood) was associated with all-cause mortality risk. Lastly, we identified lower average physical activity among women with any maternal event (versus those without a maternal event); additional differences in longitudinal physical activity were found according to birth of a first child status. These findings provide empirical evidence on the ways that childbearing and childrearing are related to cardiovascular health in women.

Keywords

Cardiovascular health;Cohort;Motherhood;Physical Activity

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