QUANTIFYING THE POTENTIAL IMPACT OF MATERNAL CARDIOVASCULAR HEALTH ON PREVENTION OF ADVERSE PREGNANCY OUTCOMES

Therapeutic Area

CVD Prevention – Primary and Secondary

Background

More favorable maternal cardiovascular health (CVH) is associated with lower risk of adverse pregnancy outcomes (APOs). However, estimates of the potential impact of improving maternal CVH on the burden of APOs are not available. We sought to estimate the proportion of APOs that could be prevented if the population distribution of maternal CVH was improved.

Methods

Pregnant participants aged ≥ 18 years enrolled in the Nulliparous Pregnancy Outcomes Study (nuMoM2b) without pre-pregnancy hypertension or diabetes were included in analyses. First trimester CVH was assessed using six-factors from the Life’s Essential 8 framework (physical activity, diet, sleep, nicotine use, body mass index, and blood pressure). CVH was scored from 0-100 with higher scores representing better CVH. APOs included new-onset hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), and preterm birth (<37 weeks gestation, PTB). The primary outcome was incidence of any APO and secondary outcomes included each APO separately. Logistic regression models assessed the association of early pregnancy CVH and APOs. Impact fractions were calculated to estimate the proportion of APOs that could be prevented if maternal CVH was improved for those with the lowest CVH scores. A priori selected covariates of study site, maternal age, insurance type, and depressive symptoms at baseline were included in analyses.

Results

Among the 8927 pregnant participants included, 25.3% experiencing an APO. A lower total CVH score was associated with a significantly higher risk of the composite APO outcome. An estimated 12% of APOs would be prevented if a hypothetical intervention shifted all participants with a CVH score <50 to a score of 50 (5.8% of participants). Moreover, a dose-response relationship was observed with 15% and 40% of APOs estimated to prevented if a hypothetical intervention shifted participants with a CVH score <80 to 80 points (51.4% of participants) or shifted everyone to 100 points (96.6% of participants), respectively (Figure 1). Similar findings were observed for each APO type.

Conclusions

In this cohort of nulliparous pregnant individuals, estimated potential benefits of improving maternal CVH to reduce APOs are considerable. Determining efficacious and equitable strategies to improve CVH pre-pregnancy or early pregnancy period are needed.