Determinants of Racial and Ethnic Differences in Maternal Cardiovascular Health in Early Pregnancy

Cameron NA 1 , Huang X 2 , Petito LC 2 , Ning H 2 , Shah NS 2 , Yee LM 3 Show all authors , Perak AM 2 , Haas DM 4 , Mercer BM 5 , Parry S 6 , Saade GR 7 , Silver RM 8 , Simhan HN 9 , Reddy UM 10 , Varagic J 11 , Licon E 12 , Greenland P 2 , Lloyd-Jones DM 2 , Kershaw KN 2 , Grobman WA 13 , Khan SS 2

Affiliations 

  • 1 Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. (N.A.C.)
  • 2 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. (N.A.C., X.H., L.C.P., H.N., N.S.S., A.M.P., P.G., D.M.L.-J., K.N.K., S.S.K.)
  • 3 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL. (L.M.Y.)
  • 4 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis (D.M.H.)
  • 5 Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, OH (B.M.M.)
  • 6 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia (S.P.)
  • 7 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston (G.R.S.)
  • 8 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City (R.M.S.)
  • 9 Department of Obstetrics and Gynecology, Magee-Women's Research Institute & Foundation, University of Pittsburgh School of Medicine, PA (H.N.S.)
  • 10 Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (U.M.R.)
  • 11 National Heart, Lung, and Blood Institute, Bethesda, MD (J.V.)
  • 12 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine School of Medicine (E.L.)
  • 13 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus (W.A.G.)
Circ Cardiovasc Qual Outcomes, 2025 Jan 14.
PMID: 39807595 DOI: 10.1161/CIRCOUTCOMES.124.011217

Abstract

BACKGROUND: Suboptimal cardiovascular health (CVH) in pregnancy is associated with adverse maternal and offspring outcomes. To guide public health efforts to reduce disparities in maternal CVH, we determined the contribution of individual- and neighborhood-level factors to racial and ethnic differences in early pregnancy CVH.

METHODS: We included nulliparous individuals with singleton pregnancies who self-identified as Hispanic, non-Hispanic Black (NHB), or non-Hispanic White (NHW) and participated in the nuMoM2b cohort study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be). First-trimester CVH was quantified using 6 routinely assessed factors in pregnancy included in the American Heart Association Life's Essential 8 score (0-100 points), in which higher scores indicate better CVH. Oaxaca-Blinder decomposition evaluated the extent to which racial and ethnic differences in CVH were explained by differences in individual- and neighborhood-level factors (age, socioeconomic characteristics, psychosocial factors, nativity, perceived racial discrimination, and area deprivation index).

RESULTS: Among 9104 participants, the mean age was 26.8 years, 18.7% identified as Hispanic, 15.6% identified as NHB, and 65.8% identified as NHW. Mean (SD) CVH scores were 76.7 (14.1), 69.8 (15.1), and 79.9 (14.3) in the Hispanic, NHB, and NHW groups, respectively (P<0.01). The individual- and neighborhood-level factors evaluated explained all differences in CVH between Hispanic and NHW groups and 82% of differences between NHW and NHB groups. Racial and ethnic differences in educational attainment explained the greatest proportion of differences in CVH. If mean years of education among the Hispanic (14.0 [2.5]) and NHB (13.4 [2.4]) groups were the same as the NHW (15.8 [2.4]) group, mean CVH scores would be higher by 2.98 points (95% CI, 2.59-3.37) in the Hispanic and 4.28 points (95% CI, 3.77-4.80) in NHB groups.

CONCLUSIONS: Racial and ethnic differences in early pregnancy CVH were largely explained by differences in individual- and neighborhood-level factors.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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