National Trends in Prepregnancy Cardiometabolic Risk and Counseling: An Analysis of the Pregnancy Risk Assessment Monitoring System, 2016-2022.

Abstract

Objective: To assess national U.S. trends in self-reported prepregnancy cardiometabolic risk factors and counseling about improving cardiometabolic health.

Methods: We analyzed data from the Centers for Disease Control and Prevention's PRAMS (Pregnancy Risk Assessment Monitoring System), a nationally representative population-based survey of postpartum individuals who had live births from 2016 to 2022. We identified prepregnancy cardiometabolic risk factors (obesity, overweight, hypertension, diabetes mellitus, smoking cigarettes or electronic cigarettes). We then tested for age-standardized trends in both cardiometabolic risk factors and prepregnancy counseling using logistic regression with survey year as a continuous variable. We examined whether patient sociodemographic factors were associated with self-reported prepregnancy counseling about cardiometabolic health, adjusting for clinical characteristics.

Results: Among 225,431 participants (weighted n=11,052,761), the majority (61.6%) reported having at least one prepregnancy cardiometabolic risk factor and 14.8% reported having two or more risk factors. Only 38.4% of individuals had optimal prepregnancy cardiometabolic health (no risk factors). The age-standardized prevalence of having a cardiometabolic risk factor increased from 59.1% in 2016 to 62.8% in 2022 (P<.001) and was driven by an increase in the prevalence of obesity from 22.4% to 28.4% (P<.001). Only 58.3% reported receiving any type of prepregnancy counseling about cardiometabolic risk, with screening for smoking most common (54.4%), followed by counseling about maintaining a healthy weight (26.9%), counseling about improving health before pregnancy (21.4%), and counseling about controlling medical conditions such as diabetes or high blood pressure (10.4%). Lower income, lower education, rural residence, and no health insurance were associated with lower odds of being counseled about cardiometabolic health.

Conclusion: Prepregnancy cardiometabolic risk factors were common among U.S. birthing people and have increased over time. Self-reported prepregnancy counseling about cardiometabolic health remains suboptimal, and there were disparities by income, education, geography, and insurance status.