Connors-BRI Symposium

Incorporating Sex as Biologic Variable to Advance Health

May 24, 2021 | 3-5PM

Virtual Event

Jennifer Stuart, ScD

Brigham and Women’s Hospital
Women’s Health


BACKGROUND: Early life abuse and preeclampsia are both associated with cardiometabolic risk factors, including chronic hypertension and type 2 diabetes. However, it is unknown whether early life abuse is associated with the risk of developing preeclampsia during pregnancy.

METHODS: Nurses’ Health Study II participants reported history of physical and sexual abuse in early life (childhood or adolescence) in 2001 and history of pregnancy complications (including preeclampsia) in 2009. Parous women with available information on early life abuse and pregnancy history comprised the study sample (n=46,212). Modified Poisson regression models were used to estimate risk ratios (RR) and 95% confidence intervals (CI) for the associations between physical and sexual abuse in early life and preeclampsia. Models were adjusted for maternal age at pregnancy, year of birth, race/ethnicity, and body size (somatogram) at age five as well as parental education, occupation, and home ownership.

RESULTS: More than half of women (53%; n=24,212) reported a history of physical abuse in early life, with 9% reporting severe abuse. A history of sexual abuse in early life was reported among 33% of women (n=15,389); 22% reported touch only sexual abuse while 11% reported a history of forced sexual activity. History of severe physical abuse in early life was associated with a 37% increased risk of preeclampsia in first pregnancy (CI: 1.19-1.57) compared to women without early life physical abuse. History of forced sexual activity in early life was associated with a 33% increased risk of preeclampsia in first pregnancy (CI: 1.19-1.48) compared to women without early life sexual abuse. Histories of mild or moderate physical abuse or touch only sexual abuse were not associated with preeclampsia risk.

DISCUSSION: Women with a history of severe physical or sexual abuse in childhood or adolescence appear to have an increased risk of developing preeclampsia during pregnancy.

Female-specific and female-predominant risk factors, such as pregnancy complications and some mental health conditions, provide opportunities to improve cardiovascular disease prevention in women. There is also growing recognition that, for some, preeclampsia may constitute a traumatic event and precipitate posttraumatic stress disorder (PTSD) and depression, both of which are twice as likely in women as in men. Women are also more likely to develop PTSD following trauma than men. Studies suggest that preeclampsia and these mental health conditions (PTSD and depression) are interrelated, but evidence, especially regarding the temporality of these relationships, is limited. Early life abuse may also be a shared risk factor for both preeclampsia and mental health conditions in adulthood. This work represents the first step in disentangling the relationship between mental health conditions, trauma, and preeclampsia across the life course in women.


3PM – Welcome Remarks
3:05PM – Keynote Address
3:45PM – Featured Short Talks
4:20PM – Lightning Talks
4:50PM – Closing Remarks

Keynote Speaker

Janine Austin Clayton, MD

Janine Austin Clayton, M.D., Associate Director for Research on Women’s Health and Director of the Office of Research on Women’s Health (ORWH) at the National Institutes of Health (NIH), is the architect of the NIH policy requiring scientists to consider sex as a biological variable across the research spectrum. This policy is part of NIH’s initiative to enhance reproducibility through rigor and transparency. As co-chair of the NIH Working Group on Women in Biomedical Careers with NIH Director Dr. Francis Collins, Dr. Clayton also leads NIH’s efforts to advance women in science careers.

Prior to joining the ORWH, Dr. Clayton was the Deputy Clinical Director of the National Eye Institute (NEI) for seven years. A board-certified ophthalmologist, Dr. Clayton’s research interests include autoimmune ocular diseases and the role of sex and gender in health and disease. She is the author of more than 120 scientific publications, journal articles, and book chapters.
Dr. Clayton, a native Washingtonian, received her undergraduate degree with honors from Johns Hopkins University and her medical degree from Howard University College of Medicine. She completed a residency in ophthalmology at the Medical College of Virginia. Dr. Clayton completed fellowship training in cornea and external disease at the Wilmer Eye Institute at Johns Hopkins Hospital and in uveitis and ocular immunology at NEI.

Dr. Clayton has received numerous awards, including the Senior Achievement Award from the Board of Trustees of the American Academy of Ophthalmology in 2008 and the European Uveitis Patient Interest Association Clinical Uveitis Research Award in 2010. She was selected as a 2010 Silver Fellow by the Association for Research in Vision and Ophthalmology. In 2015, she was awarded the American Medical Women’s Association Lila A. Wallis Women’s Health Award and the Wenger Award for Excellence in Public Service. Dr. Clayton was granted the Bernadine Healy Award for Visionary Leadership in Women’s Health in 2016. She was also selected as an honoree for the Woman’s Day Red Dress Awards and the American Medical Association’s Dr. Nathan Davis Awards for Outstanding Government Service in 2017.