New research has found that around 40% of women in the US who gave birth in 2019 had good cardiovascular health before their pregnancy.
Excess weight was the major driver of poor pre-pregnancy cardiovascular health, followed by hypertension and diabetes. Poor cardiovascular health puts both the mothers-to-be and their children at risk, with heart disease causing more than one in four pregnancy-related deaths (26.5%).
“Many women only begin having regular health care visits once they become pregnant. If women already have overweight or obesity, high blood pressure or diabetes before pregnancy, it is often not diagnosed until pregnancy. However, if identified before pregnancy, their health care clinician can help them manage and optimise these conditions before pregnancy,” said lead study author Natalie A. Cameron, MD, an internal medicine specialist and instructor at Northwestern University’s Feinberg School of Medicine in Chicago.
The findings were published in the American Heart Association’s peer-reviewed, flagship journal Circulation.
Pregnancy and heart health
The researchers analysed data from the US Centers for Disease Control and Prevention’s Natality Database 2016-2019 and identified the pre-pregnancy cardiovascular health risk factors of 14,174,625 women with live births. The women ranged in age from 20-44 years old; 81.4% were between the ages of 20 to 34; 52.7% were non-Hispanic white; 22.7% were Hispanic/Latina, and 14% were non-Hispanic Black.
Optimal cardiovascular health was defined as having a normal body weight with a Body Mass Index (BMI) between 18-24.9 kg.m2, and not having hypertension or diabetes.
The researchers found the following during their study:
- The overall percentage of women experiencing optimal pre-pregnancy heart health declined more than 3% over the three years, from 43.5% in 2016 to 40.2% in 2019.
- In 2019, the percentage of women with good heart health ranged from 37.1% amongst women aged between 40-44 years old to 42.2% amongst those aged 30-34 years old.
- More than one in two women had at least one risk factor for cardiovascular disease before becoming pregnant; these risk factors included being overweight or obese, having high blood pressure or having diabetes.
- Being overweight or obese was the most common reason for poor heart health before pregnancy.
The researchers also compared data by geographical region, and they found that good cardiovascular health was declining overall across the country, and there were geographic differences. Good heart health was lower in states in the South (38.1%) and the Midwest (38.8%) states, compared with states in the West (42.2%) and Northeast (43.6%). There were also variations amongst states, ranging from less than one-third of women in Mississippi (31.2%) having good cardiovascular health before pregnancy compared to nearly half (47.2%) in the best-performing state, Utah. These differences appear to be most impacted by social determinants of health, which may include educational status, ability to afford healthy food and neighbour characteristics.
“These geographic patterns are, unfortunately, very similar to what we see for heart disease and stroke in both men and women, and they indicate that social determinants of health play a critical role in maternal heart health as well,” said senior study author Sadiya S. Khan, M.D., M.S., FAHA, an assistant professor of medicine in the division of cardiology at Northwestern University’s Feinberg School of Medicine in Chicago. “In addition to optimising health for those interested in becoming pregnant, it’s important to focus on optimising cardiovascular health throughout young adulthood because nearly half of pregnancies are unplanned. We need to emphasise heart health across the life span.”
Driving changes in public health policy
The researchers are hoping that the findings will drive more significant changes in public health policy and societal levels.
“We need to shift the conversation from solely ‘what can women do’ to what can society do to support mothers and pregnant individuals,” Khan said. “We need federal and state-level public health policies that ensure there is equitable access to care before, during and after pregnancy, as well as an economic investment in communities to support healthy behaviours, such as green spaces for exercise and access to heart-healthy food choices.”
“In future research, we aim to specifically identify the early social and economic factors behind these state-level differences,” Cameron said. “This knowledge can also help tailor public health interventions to equitably improve the heart health of women and their children across generations in the US.”
