Geographic Differences in Prepregnancy Cardiometabolic Health in the United States, 2016 Through 2019

Cameron, Natalie A; Freaney, Priya M; Wang, Michael C; Perak, Amanda M.; Dolan, Brigid M.; O’Brien, Matthew J.; Tandon, S. Darius; Davis, Matthew M.; Grobman, William A.; Allen, Norrina B; Greenland, Philip; Lloyd‐Jones, Donald M.; Khan, Sadiya S.

doi:10.1161/circulationaha.121.057107

Cited by 10 publications

(13 citation statements)

References 3 publications

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“…23 Furthermore, prepregnancy CVH declined between 2011 and 2019 in all subgroups (race and ethnicity, geography, and socioeconomic status); lower CVH persisted among non-Hispanic Black females, pregnant individuals living in the South and Midwest United States, and those with Medicaid insurance during pregnancy. 23,24 With regard to specific factors, <50% of birthing individuals in 2018 had a normal prepregnancy body mass index (18.5–24.9 kg/m 2 ). 25,26 Levels of CVH metrics are highly correlated between the prepregnancy period and pregnancy.…”

Section: Current Status Of Cvh In Birthing Individuals In the United ...mentioning

confidence: 99%

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association

Khan¹,

Brewer²,

Canobbio³

et al. 2023

Circulation

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This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.

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Section: Current Status Of Cvh In Birthing Individuals In the United ...mentioning

confidence: 99%

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association

Khan¹,

Brewer²,

Canobbio³

et al. 2023

Circulation

Self Cite

View full text Add to dashboard Cite

show abstract

“…Several risk factors have been identified as affecting CVD-related maternal mortality. These include race, advanced maternal age, hypertension, diabetes, obesity, geographic region, income, education level, and type of insurance [ 6 , 10 , 11 ]. Black women have been shown to be at a significant risk of not only CVD-related maternal mortality but also all-cause maternal mortality [ 3 ].…”

Section: Risk Factors Including Racial Geographic and Socioeconomic D...mentioning

confidence: 99%

“…In the United States between 2016 and 2019, a serial cross-section analysis of maternal birth records demonstrated a large geographic and socioeconomic disparity preventing access to equitable healthcare for pregnant women [ 11 ]. Favorable cardiometabolic health (normal BMI, no diabetes or hypertension) in pregnant women declined significantly, with the largest decline being in the Midwest and the South compared to the West and North East regions [ 11 ]. Additionally, the higher the prevalence of high school educated women in a region, the less favorable the cardiometabolic health outcomes [ 11 ].…”

Section: Risk Factors Including Racial Geographic and Socioeconomic D...mentioning

confidence: 99%

“…Favorable cardiometabolic health (normal BMI, no diabetes or hypertension) in pregnant women declined significantly, with the largest decline being in the Midwest and the South compared to the West and North East regions [ 11 ]. Additionally, the higher the prevalence of high school educated women in a region, the less favorable the cardiometabolic health outcomes [ 11 ]. This trend can also be attributed to insurance type as well: the higher the number of women enrolled in Medicaid, the less favorable the cardiometabolic health outcomes [ 11 ].…”

Section: Risk Factors Including Racial Geographic and Socioeconomic D...mentioning

confidence: 99%

“…Additionally, the higher the prevalence of high school educated women in a region, the less favorable the cardiometabolic health outcomes [ 11 ]. This trend can also be attributed to insurance type as well: the higher the number of women enrolled in Medicaid, the less favorable the cardiometabolic health outcomes [ 11 ].…”

Section: Risk Factors Including Racial Geographic and Socioeconomic D...mentioning

confidence: 99%

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Screening for Cardiovascular Disease in Pregnancy: Is There a Need?

Chambers

Zoysa

Hameed

2022

JCDD

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Maternal mortality in the United States has been on the rise. Every year, about 700 women die from pregnancy-related complications. Cardiovascular disease (CVD) accounts for a large majority of pregnancy-related deaths driven by the lack of recognition and delays in diagnosis due to the overlap of normal pregnancy symptoms with those of CVD. Risk factors for CVD including race, advanced maternal age, hypertension, diabetes, obesity, socioeconomic status, and geographic region play an important role in CVD-related deaths. Several risk assessment models are available to stratify women with a known diagnosis of CVD. However, most women who die from CVD during pregnancy or the postpartum period do not have a prior diagnosis of CVD, and cardiomyopathy is an important contributor. The California Maternal Quality Care Collaborative (CMQCC) developed an algorithm to screen all pregnant and postpartum women to allow stratification into low or high risk for CVD. The algorithm has been validated in diverse patient populations. We propose universal CVD screening for all women in the antepartum and postpartum period to identify women at risk and to provide education and awareness for both patients and healthcare providers. This screening tool would work to reduce the increasing rates of severe maternal mortality and morbidity while having a significant impact on healthcare costs in the United States.

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Antiabortion Laws and Implications for Patients With Cardiovascular Disease in Pregnancy

2022

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Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the US. 1 State-based antiabortion legislation is associated with maternal mortality, particularly among those with CVD. 2,3 Conditions such as aortopathies, cardiomyopathies, valvular heart disease, and complex congenital heart disease place patients at high risk for complications during pregnancy. 4,5 Shared decision-making regarding pregnancy termination occurs when high maternal risk exists or when pregnancy interferes with medical or surgical treatment. 4 State antiabortion laws limit abortion access, 2,6 impede shared decision-making with patients, and increase racial and socioeconomic disparities in maternal mortality. 2 The pending decision of the Supreme Court of the US (SCOTUS) in Dobbs v Jackson Women's Health Organization could eliminate abortion rights for patients, including those with CVD, further perpetuating unequal pregnancy outcomes.For patients with CVD, abortion access is a critical part of their comprehensive cardiovascular and reproductive care. 4 Pregnancy can exacerbate preexisting cardiovascular conditions, eg, cardiomyopathies and arrythmias, and lead to acquired conditions, including peripartum cardiomyopathy or spontaneous coronary artery dissection. 4 Modified World Health Organization (WHO) class III to IV conditions confer a more immediate cardiovascular morbidity during pregnancy, 4,5 and pregnancy should be discouraged in class IV conditions. 2,5 Sequelae from cardiovascular decompensation during pregnancy can affect patients' functional status, ability to raise children, and future cardiovascular health. 1,4 Barriers to abortion access increase the likelihood of pregnancy continuation, 7 which may be contraindicated in WHO class III to IV conditions. 4,5 Over 500 state antiabortion laws already decrease and delay abortions, increase logistical burdens on patients, and create inequitable access. 6 Restrictive abortion policies are associated with maternal mortality during pregnancy and the postpartum period. 2,3 Midwestern and Southern states with more antiabortion laws have higher rates of total maternal mortality. 2 These regions have concomitantly high CVD burden 7 and the lowest prevalence of favorable prepregnancy cardiometabolic health. 8 Maternal death in restrictive abortion settings is attributable to patients with chronic diseases, such as adult congenital heart diseases and CVD, being unable to access an abortion. 2,8 The COVID-19 pandemic exacerbated existing barriers, including cost, scheduling difficulties, securing childcare, travel distances, and lack of transportation. 4,7 Black and Indigenous patients, individuals in rural areas, and those of lower socioeconomic status (SES) 2

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Geographic Differences in Prepregnancy Cardiometabolic Health in the United States, 2016 Through 2019

Abstract: The podcast and transcript are available as Supplemental Material at https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.121.057107.

Cited by 10 publications

References 3 publications

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association

Screening for Cardiovascular Disease in Pregnancy: Is There a Need?

Antiabortion Laws and Implications for Patients With Cardiovascular Disease in Pregnancy

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