Sarah Winthrop is the only daughter and firstborn child of Ethan Winthrop and Gwen Hotchkiss. Ethan is prepared to propose to his former fiancée, Theresa Lopez-Fitzgerald Crane, when Gwen Hotchkiss reveals that she was pregnant with his child. She insists that he not propose to her only because she is pregnant, explaining that she will move to New York City and raise their child on her own. However, after careful deliberation, Ethan proposes to Gwen, who accepts, much to Theresa's dismay.
Gwen's pregnancy is difficult, however, and she and Ethan decide to fly to Los Angeles mid-year 2003 so that she can be under the care of a specialist, Dr. Abel, and so that she can gain some distance from Theresa. However, Theresa also decides to spend her summer in Los Angeles with friends Chad Harris and Whitney Russell, hoping to give Ethan and Gwen some space. While Gwen lies on bedrest in the hospital, Ethan finds himself drawn to Theresa, and, while drunk, makes out with Theresa on the beach.
At the hospital, Gwen is watching TV when, during a news report, she sees Ethan and Theresa on the beach. Furious, Gwen leaves the hospital and returns to the Cranes' apartment complex, convincing herself along the way that she saw wrong and will talk things out with Ethan and return to the hospital. However, upon arriving at the apartment, she finds Theresa, whom she did not known to be in Los Angeles. The two wind up in a physical altercation that leads to Gwen falling and becoming unconscious.
Gwen is rushed back to the hospital, where Ethan is given the choice between saving his wife or his unborn child. Despite Theresa's insistence that he save his baby, Ethan chooses to save Gwen. Though Gwen lives, their daughter is stillborn on October 7, 2003. When Gwen awakes, she is devastated, and they have their baby posthumously baptized as Sarah before burying her in Harmony.
Gwen resolves to leave Ethan after Sarah's death, but after he swears on their daughter's grave to never leave her for Theresa again, Gwen agrees to take him back. As retaliation for Sarah's death, Gwen's mother, Rebecca, arranges for Gwen and Ethan to adopt Theresa's son, Little Ethan. Sarah's death is a driving force for several storylines throughout the remainder of 2003 and through 2004 and 2005; ramifications are still felt in present storylines. After Sarah's death and Ethan and Gwen's adoption of Little Ethan, the couple try to use a surrogate to carry their child; Theresa, however, replaces their surrogate in an attempt to use Ethan and Gwen's child to trade for Little Ethan. Through a series of events, however, Theresa becomes pregnant with both Ethan and Gwen's son and her own daughter with Ethan; Theresa is later forced to terminate one fetus to save the other, and Ethan and Gwen's son does not survive. Gwen is devastated to have lost her last chance at having a biological child, and she and Ethan sue for and win custody of Ethan and Theresa's daughter, Jane; Theresa and Gwen fight over custody of Jane for more than a year. Theresa also fights to win Ethan back, but Ethan refuses to leave his wife largely out of guilt for his role in Sarah's death. Gwen's denial over her son Jonathan's illness also stems from her inability to accept the fact that she could lose another child like she lost Sarah.
In August 2008, it was revealed that Gwen was already married when she married Ethan but do to no memory of that marriage.
- Gwen Hotchkiss (mother)
- Ethan Winthrop Sr. (father)
- Theresa Winthrop (step-mother)
- unnamed man (step-father)