Social Determinants of Suboptimal Cardiovascular Health Among Pregnant Women in the United States

Abstract

Background Suboptimal cardiovascular health (CVH) and social determinants of health (SDOH) have a significant impact on maternal morbidity and mortality. We aimed to evaluate the association of SDOH with suboptimal CVH among pregnant women in the United States. Methods and Results We examined cross‐sectional data of pregnant women aged 18 to 49 years from the National Health Interview Survey (2013–2017). We ascertained optimal and suboptimal CVH based on the presence of 0 to 1 and ≥2 risk factors (hypertension, diabetes, hyperlipidemia, current smoking, obesity, and insufficient physical activity), respectively. We calculated an aggregate SDOH score representing 38 variables from 6 domains (economic stability; neighborhood, physical environment, and social cohesion; community and social context; food; education; and healthcare system) and divided into quartiles. We used Poisson regression model to evaluate the association of SDOH with suboptimal CVH and risk factors. Our study included 1433 pregnant women (28.8±5.5 years, 13% non‐Hispanic Black). Overall, 38.4% (95% CI, 33.9–43.0) had suboptimal CVH versus 51.7% (95% CI, 47.0–56.3) among those in the fourth SDOH quartile. Risk ratios of suboptimal CVH, smoking, obesity, and insufficient physical activity were 2.05 (95% CI, 1.46–2.88), 8.37 (95% CI, 3.00–23.43), 1.54 (95% CI, 1.17–2.03), and 1.19 (95% CI, 1.01–1.42), respectively among those in the fourth SDOH quartile compared with the first quartile. Conclusions Over 50% of pregnant women with the highest SDOH burden had suboptimal CVH, highlighting the public health urgency for interventions in socially disadvantaged pregnant women with renewed strategies toward improving modifiable risk factors, especially smoking and insufficient physical activity.

JAHA Spotlight on Pregnancy and Its Impact on Maternal and Offspring Cardiovascular Health

“…As described in Sharma et al in this issue, 6 the cardiovascular health of pregnant women is strongly affected by social determinants. In their study, the investigators examined 1433 pregnant women across the United States and scored them for 38 variables across 6 social domains (economic stability; neighborhood, physical environment, and social cohesion; community and social context; food; education; and health care system).…”

Social Determinants of Health on Cardiovascular Disease Prevention in Special Populations: An Overview

“…The impact of poor maternal health CVH lasts beyond pregnancy [32]. Focusing on clinical care during prenatal and post-partum care is a critical first step to preventing maternal mortality [32].…”

“…The impact of poor maternal health CVH lasts beyond pregnancy [32]. Focusing on clinical care during prenatal and post-partum care is a critical first step to preventing maternal mortality [32]. Pregnancy complications, such as hypertensive disorders, affect a woman's long-term health and require specific attention [32].…”

“…Focusing on clinical care during prenatal and post-partum care is a critical first step to preventing maternal mortality [32]. Pregnancy complications, such as hypertensive disorders, affect a woman's long-term health and require specific attention [32]. Early post-partum visits should evaluate complications from pregnancy and common post-partum medical complications [33].…”

“…Family physicians can provide prenatal care, labor and delivery, post-partum care, and primary care before and after pregnancy [33]. The American College of Obstetricians and Gynecologists (ACOG) recommends a post-partum evaluation within the first three weeks after delivery in person or by phone, with a complete bio-psychosocial assessment completed within 12 weeks post-partum [32]. The World Health Organization recommends visits at three days, seven to 14 days, and six weeks post-partum, including newborn care [32].…”