Synergistic effects of cardiovascular health and social isolation on adverse pregnancy outcomes

Background: Adverse pregnancy outcomes affect approximately 20% pregnant women, and their incidence is increasing. Objective: To investigate the effect of cardiovascular health during pregnancy on adverse pregnancy outcomes and the effect modification by psychological distress, social isolation, and income. Study Design: We analyzed data from 14,930 pregnant women in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Cardiovascular health status during pregnancy was assessed using the eight components of Lifes Essential 8 as proposed by the American Heart Association, including diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. Adverse pregnancy outcomes were defined as composite outcomes of preeclampsia, gestational diabetes mellitus, preterm birth, and small for gestational age. Using logistic regression analyses, we examined the associations between cardiovascular health and adverse pregnancy outcomes, preeclampsia, gestational diabetes mellitus, preterm birth, small for gestational age, large for gestational age, low birth weight, and neonatal intensive care unit admission. Interactions with psychological distress, social isolation, and income were examined. Results: The numbers of participants with high, moderate, and low cardiovascular health status were 2,891 (19.4%), 11,498 (77.0%), and 541 (3.6%), respectively. Moderate and low cardiovascular health status were positively associated with adverse pregnancy outcomes (odds ratio and 95% confidence interval: 1.17 (10.04 to 1.32) and 2.64 (2.13 to 3.27), respectively). Low cardiovascular health status was also associated with a higher prevalence of preeclampsia, gestational diabetes mellitus, preterm birth, large for gestational age, and neonatal intensive care unit admission, and lower prevalence of small for gestational age. Among pregnant women with low cardiovascular health status, those who reported social isolation had a higher prevalence of adverse pregnancy outcomes than did those without social isolation (36.4% vs. 27.4%). However, this difference was attenuated for pregnant women with high cardiovascular health status (13.6% vs. 13.1%). Conclusions: Cardiovascular health status assessed using Lifes Essential 8 may be useful for assessing the risk of adverse pregnancy outcomes. Socially isolated pregnant women are more vulnerable to the effects of low cardiovascular health status; thus, they should be prioritized for access to primary care, lifestyle education, and appropriate pharmacotherapy.