Pregnancy Complications and Cardiometabolic Health in American Indian Women Project Summary Cardiovascular health is closely linked with pregnancy health. Cardiovascular morbidity and mortality are predicted by pregnancy complications such as hypertensive disorders of pregnancy (gestational hypertension and pre-eclampsia), gestational diabetes, or giving birth to an infant with fetal growth restriction (measured as small-for-gestational-age or low birthweight) or preterm birth. Pregnancy thus serves as a signal of possible future health issues, as well as an opportunity to identify those who might benefit from interventions. Although there are wide racial and ethnic disparities in both pregnancy complications and cardiovascular health, most studies addressing the relationship between the two have been conducted in White populations. American Indian women are at high risk for pregnancy complications and adverse birth outcomes, but the group is understudied, with few or no large-scale studies that address reproductive health. The goal of this supplement will therefore be to examine reproductive history in women's life course of cardiovascular and metabolic health in an American Indian cohort, with the following specific aims: 1) To assess quality of self-report of reproductive health in an American Indian cohort; 2) To characterize pre-eclampsia and gestational diabetes in an American Indian cohort; 3) To examine the effect of pregnancy complications on echocardiographic parameters. The project will build on data collected in the Strong Heart Study. Medical records of female participants who reported pre-eclampsia, hypertension during pregnancy, or gestational diabetes, as well as a comparison group of women who did not report these conditions, will be reviewed; self-report of pregnancy complications will be analyzed relative to later cardiometabolic health and changes in echocardiographic parameters. SHS presents an ideal opportunity to examine the relationship between CVD and reproductive health in American Indian women, but additional data collection is needed to bring this promise to fruition. This project will provide information on a) the quality and validity of the existing data, and b) the relationships between cardiovascular and reproductive health in the existing data. To our knowledge, this will be the first study examining the quality of self-report information on pregnancy in American Indian women, as well as the first large study to be able to investigate the relationship between pregnancy complications and cardiometabolic health in American Indian women in detail. This will lay the groundwork for further study relating reproductive experience and history to life course cardiometabolic health in an important, understudied, and high-risk ethnic group, American Indians.