Socioeconomic status during early pregnancy may play a large role in future heart health

Research Highlights:

• The socioeconomic status of first-time moms in early pregnancy may affect their cardiovascular health up to seven years later.
• Socioeconomic status -- education level, income level, health insurance status and health literacy -- of pregnant individuals was responsible for more than half of the long-term heart health disparities among Black, Hispanic and white women, according to a new study.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association's scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal.

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 11, 2024

(NewMediaWire) - November 11, 2024 - DALLAS -- Differences in socioeconomic status during early pregnancy may explain the majority of the disparities in cardiovascular health years later among women in different racial and ethnic groups, according to a preliminary study to be presented at the American Heart Association's Scientific Sessions 2024. The meeting, Nov. 16-18, 2024, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

This study of more than 4,000 pregnant individuals examined the effect of social determinants of health in early pregnancy among Black, Hispanic and white women. The study aimed to determine how social factors contribute to racial and ethnic differences in maternal heart health up to seven years after delivery.

"Pregnancy can have long-term consequences on women's cardiovascular health, and it's an important opportunity to provide preventive care, especially for individuals with cardiovascular risk factors," said study first author Xiaoning "Jack" Huang, Ph.D., a research assistant professor of medicine at Northwestern University's Feinberg School of Medicine in Chicago. "This research adds a further dimension to what is known about what explains the significant racial disparities that exist in cardiovascular health among birthing individuals."

This study assessed the differences in demographics (age and ethnicity), socioeconomic status (education, income, health insurance and health literacy) and psychosocial health factors (resilience, social support, depression, anxiety and stress) in early pregnancy to see how these factors may affect racial and ethnic disparities in cardiovascular health after delivery.

Using data from a study called nuMoM2b-HHS, researchers calculated cardiovascular health scores, based on the American Heart Association's Life's Essential 8 metrics of ideal heart health, for more than 4,000 first-time mothers collected two to seven years after delivery. The metrics include body mass index, blood pressure, cholesterol, blood sugar, diet, physical activity, sleep health and smoking status. Based on the measures of these health metrics, each study participant was assigned a heart health score from 0 to 100. Higher scores indicate better cardiovascular health.

Researchers used a statistical modeling program to estimate how the differences in demographics, socioeconomic status and psychosocial health factors across all three racial and ethnic groups of the women during early pregnancy appeared to affect cardiovascular health scores from two to seven years after delivery. 

The analysis found:

• After adjusting for demographic, socioeconomic and psychosocial factors, the average cardiovascular health score of white mothers was 12.2 points higher than Black mothers and 3.3 points higher than Hispanic mothers.
• Socioeconomic status in early pregnancy had the greatest impact on heart health scores.
• When socioeconomic data for Black women was adjusted to match white counterparts in the study, the cardiovascular health score for Black women was 6.6 points higher, effectively removing more than 50% of the cardiovascular health difference between the two groups.
• When socioeconomic data was adjusted for Hispanic women to align with white counterparts in the study, their cardiovascular health scores were 3.9 points higher -- erasing the cardiovascular health score gap between white and Hispanic women.

"Socioeconomic status is very important, however, I am surprised that it appears to explain the majority of the differences in cardiovascular health two to seven years after giving birth," Huang said. "For some people, their socioeconomic status probably doesn't change that much during this period. So, if in an ideal society we could have similar socioeconomic status across racial-ethnic groups, then most of the disparities in cardiovascular health may be eliminated."

"This data is critically needed," said Vesna D. Garovic, M.D., Ph.D., an American Heart Association volunteer expert and professor of Medicine and director of the Mayo Clinic Center for Clinical and Translational Science at Mayo Clinic in Rochester, Minnesota.

"Despite an increasing awareness of racial and ethnic differences in postpartum cardiovascular outcomes, few studies have addressed the role of socioeconomic status in large, prospective and well-designed cohorts like this one," Garovic said. "Identifying the role of socioeconomic status in postpartum cardiovascular health provides supporting data to augment affordable preventive postpartum care, such as extending Medicaid postpartum coverage to one year."

As of October 2024, 47 states and the District of Columbia have expanded Medicaid, giving millions of families with low incomes access to health care they could not previously afford. The expansion provides health insurance coverage for people who have just given birth from 60 days to one year to help address maternal health disparities.

Garovic, who chaired the Association's 2021 Scientific Statement Hypertension in Pregnancy added that, "Recent trends indicate that the United States is the only developed country with an increasing maternal death rate. Poor care before, during and after a birth has been shown to play a role, and Black, non-Hispanic women seem to be disproportionately affected. Public health policies that reflect the impact of structural racism on maternal health and health care in the United States are urgently needed."

According to Huang and his research team, the results support enhancing the accessibility and affordability of health care so that people who are more socioeconomically disadvantaged receive the preventive care they need.

"The scientific community has produced clear evidence highlighting the critical importance of social determinants of health, including economic opportunities and accessible, affordable health insurance," Huang said. "Medicaid extension and expansion can go a long way in promoting health equity for everybody across the life course."

A key study limitation is that it was observational, meaning the findings can only establish an association, they cannot prove a direct cause and effect. Other factors like hypertensive disorders of pregnancy and gestational diabetes, which were not included in the analysis, may also influence cardiovascular health after pregnancy.

Study details, background and design:

• 4,161 first-time mothers in their first trimester of pregnancy (17% Hispanic, 15% Black and 67.3% white) were included in the analysis.
• The current analysis included data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b), conducted between 2010 and 2013 at eight U.S. academic medical centers and its follow-up Heart Health Study (nuMoM2b-HHS), conducted two to seven years after nuMoM2b.
• A cardiovascular health score was created for each participant based on the American Heart Association's Life's Essential 8 score, which includes diet, physical activity, sleep, smoking status, blood sugar, blood pressure, cholesterol and body mass index.
• The analysis quantified to what extent the differences in demographics, socioeconomic status and mental health factors in early pregnancy explained the racial and ethnic disparities in cardiovascular health for 2-7 years after delivery.

Co-authors, disclosures and funding sources are listed in the abstract. The research was partially funded by Dr. Huang's American Heart Association Career Development Award.

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association's scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

 The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association's overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of the release link https://newsroom.heart.org/news/socioeconomic-status-during-early-pregnancy-may-play-a-large-role-in-future-heart-health?preview=62806398b064c52535dc9ae88701e226
• Spanish news release
• Link to abstract; and AHA Scientific Sessions 2024 Online Program Planner
• AHA health information: Pregnancy and Maternal Health
• AHA news release: Heart disease risk factors in women highlight need for increased awareness, prevention (Feb. 2024)
• AHA news release: Wider access to health insurance via Medicaid expansion improved cardiac care  (June 2023)
• AHA news release: Hispanic women face inequities affecting maternal health outcomes (April 2022)
• AHA news release: Black women of childbearing age more likely to have high blood pressure, raising pregnancy risks (Feb. 2023)
• AHA news release: Socioeconomic status may be an uneven predictor of heart health (Sept. 2023)
• For more news at AHA Scientific Sessions 2024, follow us on X @HeartNews, #AHA24

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