The research pathway · Status reviewed October 26, 2026

Carry the history forward.
Test what it can tell us.

A practical education campaign now. A defined scientific pathway to learn whether pregnancy and midlife history can improve cardiovascular risk assessment.

What WHI could help us study ↓The role of a pregnancy cohort ↓

The research question: does pregnancy history add useful information beyond current risk factors—and does that information help women receive more appropriate care?

People & conversations already helping shape the next step

Specific support.
Clearly defined next steps.

Clinical experience & cohort exploration

Dr. Rubén Quintero

Dr. Quintero treated Lisa’s sons during her TTTS pregnancy. Their story is featured on The Fetal Institute’s patient-testimonial page.

Lisa confirms that Dr. Quintero has offered his cohort as a potential research starting point. The next step is to define which participants and records are included, whether maternal cardiovascular information and follow-up are available, and the permissions and approvals needed for the agreed study. No hospital delivery partner is secured.

Watch Maurice & Peter’s story ↗Cohort offered, as confirmed by Lisa · Scope and access arrangements to define

New Jersey academic connections

Rutgers Office for Research

Lisa is in discussions with the Office for Research. Vince Smeraglia has offered to connect her with a clinical team, and a discussion is scheduled for October 28, 2026.

The opportunity is to identify appropriate clinical, methods and technical expertise for a feasible study. Research introductions are being explored alongside a separate facility-validation discussion.

Exploratory discussions · No Rutgers study or funding committed

Existing data & manuscript feasibility

WHI investigator conversations

Lisa met with WHI investigators in September 2026. Follow-up guidance directed her to the manuscript-proposal process, variable search, specimen results and the BA22 cardiovascular biomarker study.

The next step is a narrow, non-duplicative question, a sponsoring investigator and statistician, and confirmation that the required data overlap.

Feasibility stage · No approved WHI project or data access claimed

Discussion status is based on Lisa’s confirmation and her correspondence. These are individual conversations and proposed research paths, not an institutional partner or endorsement list.

The next conversation · Wednesday, October 28, 2026

Define the first study.
Build the right team.

Lisa’s scheduled Rutgers discussion is an opportunity to explore research support alongside the existing technical and facility questions. The immediate aim is a feasible study and a named next step. It is not a hospital-pilot launch.

Identify the right investigator.

Ask for an introduction to a clinical investigator and a biostatistician who can assess the maternal cardiovascular question and the available cohort.

Request a cohort inventory.

Start with aggregate counts and a list of available fields: mothers versus children, pregnancy dates and diagnoses, maternal measurements, outcomes, and duration of follow-up. Check whether menstrual or menopause history and dates are available; age alone should not be used to assume a life stage. This inventory determines which life-course questions are feasible.

Choose a question the data can answer.

Determine whether the first project should assess data feasibility, care gaps, or longer-term outcomes. A prediction-model study needs its own design and adequate data; it is not assumed to be the first deliverable.

Leave with an owner and a date.

Agree who will coordinate with Dr. Quintero, the next feasibility deliverable, and a follow-up date. Confirm the responsible institution, access process, oversight and funding route before starting study work.

Meeting scheduled; research roles and institutional commitments remain to be agreed. The proposed New Jersey hospital pilot and national rollout have separate delivery, staffing and funding requirements.

Women’s Health Initiative

We can learn from
data already collected.

WHI enrolled postmenopausal women ages 50–79 in the 1990s and has followed health outcomes for decades. It is relevant to later-life cardiovascular questions. It is not a cohort of women currently recovering from childbirth.

When is WHI “done”?

As reviewed October 26, 2026, NHLBI describes the current extension as running through 2026. That is not a confirmed permanent closing date or a date when all results become available. WHI’s May 6, 2025 update says the earlier non-renewal decision was rescinded.

We do not need to wait for a final study end date to propose an analysis. WHI already releases cumulative datasets to approved investigators. The next release, available follow-up and access requirements must be confirmed with WHI.

NHLBI study timeline ↗ · WHI funding update ↗ · Data access process ↗

Information we could request	What is documented	How it could help this project
Pregnancy complications Form 158 · 2017 survey ↗	Self-reported preeclampsia/eclampsia, gestational hypertension, gestational diabetes or pregnancy-related high blood sugar, birth at least three weeks early, and low or high infant birth weight.	Define pregnancy-history groups and examine their later cardiovascular outcomes. These are recalled diagnoses; the form does not provide a complete, verified record of every pregnancy.
Menstrual & reproductive history Form 31 dictionary ↗	Age at first period, menstrual irregularity, reproductive history, breastfeeding and gynecologic surgery history; menopausal timing and related variables require confirmation in the relevant files.	Study whether selected reproductive factors help explain risk in postmenopausal women. This does not directly measure the hormonal changes of today’s perimenopausal patient.
Standard cardiovascular measures BA22 study documentation ↗	Blood pressure, smoking, diabetes, body-size measures, and lipid measurements in defined samples. Laboratory availability and measurement dates vary.	Compare against an established model only when all required inputs, eligible ages, outcome definitions and follow-up align. PREVENT kidney-function inputs cannot be assumed to exist for everyone.
Lipoprotein(a) & other biomarkers BA22 biomarker work ↗	BA22 documents Lp(a), ApoB and other biomarkers in a selected case-cohort sample. It is not a universal biomarker panel for all WHI participants.	Check whether enough participants have both pregnancy-history responses and Lp(a) measurements to test Lisa’s focused question about hypertensive pregnancy history plus Lp(a). Appropriate sampling weights and assay details would be needed.
Clinical outcomes ASCVD study ↗ · Heart-failure study ↗	Published WHI analyses have linked adverse pregnancy histories with atherosclerotic cardiovascular disease and, in a defined subcohort, heart failure.	Test a clearly specified outcome and time horizon. The original studies already establish relevant associations; a new project must address a distinct question about prediction, mechanisms or care.

One focused candidate question · Feasibility first

Does considering hypertensive pregnancy history together with Lp(a) improve later cardiovascular risk assessment beyond established predictors?

Confirm the participant overlap and event counts first. If feasible, compare the existing model with a prespecified extension. Evaluate how closely predictions match observed events, whether risk ranking improves, and whether the information changes useful clinical decisions.

This is a hypothesis to test. A positive association does not guarantee that adding a variable will improve an individual risk score.

What would make the analysis credible

Ask a better question.
Use the right people and data.

Check what is already answered.

Review published and approved WHI proposals, then work with a sponsoring investigator to define a novel question. Existing WHI findings should strengthen the campaign’s evidence base, not be presented as a new HEART RESERVE discovery.

Align the dates.

Pregnancy histories were recalled in 2017, long after many baseline measurements. Define the prediction start date and count subsequent events consistently. Address recall error, survival to the questionnaire and missing responses; do not combine measurements from incompatible time points.

Use an eligible comparison group.

For a PREVENT comparison, use adults within its intended ages and without known cardiovascular disease, with the required inputs and suitable follow-up. Many WHI participants were already older than 79 by the pregnancy-history survey.

Measure value and fairness.

Assess calibration, discrimination and decision usefulness, with uncertainty. Examine results across racial and ethnic groups and relevant life stages when sample sizes allow. Independent validation in a separate contemporary cohort is still required.

The first deliverable is a feasibility report.

Count the overlap between pregnancy-history responses, reproductive variables, usable risk-model inputs, biomarkers and subsequent events. Show missingness and follow-up. That report determines whether to proceed, narrow the question or choose another cohort. It is more useful than promising a new calculator before the data are available.

A separate clinical research path

What a pregnancy
cohort could add.

Start with the cohort Dr. Quintero has offered and establish what it can answer. Confirm whether the available information concerns mothers, their children, or linked families; the maternal-heart-health question needs suitable maternal data. Do not assume the cohort consists of currently postpartum women, New Jersey residents, or women with hypertensive pregnancy.

Record the pregnancy accurately.

With appropriate approval and consent or an approved waiver, use maternal records to confirm diagnoses, gestational age, pregnancy-related cardiac events, procedures and timing. Include a suitable comparison group and distinguish TTTS-specific questions from broader adverse pregnancy outcomes.

Follow the mother over time.

Measure maternal blood pressure, metabolic and kidney health, subsequent clinical diagnoses, symptoms and follow-up completion at defined intervals. Collect current risk-model inputs in a consistent way. A small feasibility cohort can assess data quality and care gaps; it cannot establish a broadly accurate national prediction model.

Connect the clinical and methods teams.

Potential Rutgers introductions could help identify maternal-fetal medicine, cardiovascular, informatics and biostatistics expertise. Roles, access, funding, enrollment and study ownership must be agreed with the institutions involved.

Education can begin while research develops.

The campaign’s immediate goal remains documented pregnancy history and completion of indicated follow-up. Research would test whether additional information improves prediction or care. An unvalidated formula should not be used to assign extra “heart years” or replace PREVENT.

Primary sources

Read the underlying work.

WHI pregnancy-history questionnaire, Form 158 (2017)WHI reproductive-history data dictionary, Form 31 BA22: CVD prediction and biomarker study Søndergaard et al. (2020): pregnancy outcomes and ASCVD Hansen et al. (2021): pregnancy outcomes and heart failure Cook et al. (2018): Lp(a) and CVD prediction among women WHI manuscript-proposal process Working with WHI data and access requirements

The national opportunity

A stronger history.
A stronger evidence base.

Support an education effort that helps women reach care now, alongside an academic research pathway that tests what pregnancy and midlife information can add.

Read the congressional proposal →Meet Lisa & review her work →