Poor pre-pregnancy cardiometabolic health observed in the United States

Geography serves as a marker for broader socioeconomic and racial gaps, which public health policies and efforts can curb.

More than half of women who gave birth in the United States in 2019 had poor cardiometabolic health, and time trends suggest the situation is getting worse, according to research published Monday in a special issue of Go Red for Women. Traffic.

With many studies linking pregnancy complications like preeclampsia and gestational diabetes to worse long-term cardiovascular outcomesthe researchers say improving the overall health of women before they become pregnant should be a priority for policy makers and primary care clinicians.

The researchers say that while this is a significant problem across the United States, it may be particularly important to target states where a low percentage of women enter pregnancy in ideal cardiometabolic health. Hopefully, future efforts can “identify factors that may contribute to this, such as access to health care, access to healthy food and green spaces, and neighborhood safety,” lead author Natalie A. Cameron, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), told TCTMD.

Geography as a surrogate marker

Using maternal birth records from the U.S. Centers for Disease Control and Prevention, researchers identified more than 14 million women ages 20 to 44 who gave birth in the U.S. between 2016 and 2019. Good health cardiac (defined as a body mass index of 18.0 to 24.9 kg/m2 without hypertension or diabetes) averaged lowest in the Southern (38.1%) and Midwestern (38.8%) states and highest in the West (42.2%) and Northeast (43.6%).

Commenting on the study, Vesna Garovic, MD, PhD (Mayo Clinic, Rochester, MN), told TCTMD that “geography really serves as a surrogate marker for socioeconomic status, education, and racial disparities in delivery of maternal health care, which differs from state to state. The same states that have these unfavorable profiles for pregnancy in the United States have unfavorable cardiometabolic profiles for the general population, which kind of has implications again important for overall health. But for pregnant women in particular, who are stressed by weight, lipid changes and fluid retention, the implications are more pronounced, she added.

Cameron was surprised to see such a low percentage of women entering pregnancy with good cardiometabolic health, which overall declined from 43.5% in 2016 to 40.2% in 2019. “I thought that number was pretty low. given that these are women of childbearing age,” she said. “We looked at women ages 20 to 44, but that’s still young enough to only have 40% of them entering pregnancy with favorable cardiometabolic health.”

Notably, 81.4% of the population was between 20 and 34 years old. Overall, 22.7% were Hispanic/Latin, 14% were non-Hispanic black, and 52.7% were non-Hispanic white. Although the database used for the study did not include any post-pregnancy data, the researchers observed an inverse correlation between favorable cardiometabolic health and a high school diploma or less, as well as with Medicaid (P

“There are certainly a lot more social and economic factors that we need to look at to help design policies,” Cameron said.

“At the individual patient level, we would like more women to see their primary care physician before pregnancy for regular check-ups to ensure they have normal blood pressure, do not have diabetes or prediabetes, that they’re not a smoker, and that they’re of normal weight so that their doctors can help them manage those conditions if they have any,” she added. “And that way they can help maximize the health of their pregnancy and their baby too.”

For patients who experience cardiometabolic complications during pregnancy, Cameron advised doctors to look for risk factors as early as possible “to try to optimize them for the future pregnancy.” For those already entering pregnancy with poor cardiometabolic health, it’s never too late to make improvements, she said.

Garovic said healthy diet and exercise are important, but doctors need to work with women who want to start a family in a timely manner so they are healthy when they become pregnant.

Unfortunately, the data suggests “that what was bad is getting worse,” she added, noting, however, that “it may be the population that is particularly motivated to pursue these lifestyle changes in order to ‘achieve their reproductive goals’.

Going forward, Garovic would like research to focus on identifying markers of preclinical abnormalities associated with increased risk of cardiovascular disease beyond what is currently included in typical risk factor stratification. “Pre-pregnancy and pregnancy outcomes may play a role in how we assess overall risk, but unfortunately at this stage, even though we are aware that pregnancy complications may increase their risk of heart disease and stroke, these are not factored in and calculated into traditional risk scores,” she said.

Comments are closed.