Pregnancy complications and prenatal mental health are associated with elevated risk for cardiometabolic and mental health disorders later in life, but the mechanisms linking pregnancy to midlife outcomes are not well defined.  Because sleep and physical activity shape cardiometabolic regulation and mental wealth, we hypothesize that sleep patterns and physical activity in middle adulthood partially mediate the long-term associations between (1) pregnancy complications and midlife cardiometabolic health, (2) pregnancy complications and midlife mental health, and (3) prenatal mental health and midlife cardiometabolic health. 

Existing cohort data collected during pregnancy will be used to classify pregnancy complications (preeclampsia, gestational hypertension, small-for-gestational birth, preterm birth) from medical records and to quantify prenatal mental health from questionnaires. During the ongoing 11–16-year follow-up, participants are instructed to wear a wrist actigraphy device for seven days to derive objective measures of sleep duration, sleep quality/continuity, sleep regularity, and physical activity. Raw actigraphy files are scored and quality-checked, then merged with midlife outcomes. Regression-based causal mediation models in R will estimate indirect effects through sleep and physical activity.  

It is expected that women with pregnancy complications and poorer prenatal mental health will show worse midlife cardiometabolic and mental health profiles, and that shorter, lower-quality sleep and lower physical activity will account for part of these associations.  Findings will clarify whether sleep and physical activity represent modifiable pathways, linking pregnancy experiences to later-life health.