Cardiovascular Health Among Pregnant Women, Aged 20 to 44 Years, in the United States

Abstract

Background Pregnancy is a cardiometabolic stressor and thus a critical period to address women's lifetime cardiovascular health (CVH). However, CVH among US pregnant women has not been characterized. Methods and Results We analyzed cross-sectional data from National Health and Nutrition Examination Surveys 1999 to 2014 for 1117 pregnant and 8200 nonpregnant women, aged 20 to 44 years. We assessed 7 CVH metrics using American Heart Association definitions modified for pregnancy; categorized metrics as ideal, intermediate, or poor; assigned these categories 2, 1, or 0 points, respectively; and summed across the 7 metrics for a total score of 0 to 14 points. Total scores 12 to 14 indicated high CVH; 8 to 11, moderate CVH; and 0 to 7, low CVH. We applied survey weights to generate US population-level estimates of CVH levels and compared pregnant and nonpregnant women using demographic-adjusted polytomous logistic and linear regression. Among pregnant women, the prevalences (95% CIs) of ideal levels of CVH metrics were 0.1% (0%-0.3%) for diet, 27.3% (22.2%-32.3%) for physical activity, 38.9% (33.7%-44.0%) for total cholesterol, 51.1% (46.0%-56.2%) for body mass index, 77.7% (73.3%-82.2%) for smoking, 90.4% (87.5%-93.3%) for blood pressure, and 91.6% (88.3%-94.9%) for fasting glucose. The mean total CVH score was 8.3 (95% CI, 8.0-8.7) of 14, with high CVH in 4.6% (95% CI, 0.5%-8.8%), moderate CVH in 60.6% (95% CI, 52.3%-68.9%), and low CVH in 34.8% (95% CI, 26.4%-43.2%). CVH levels were significantly lower among pregnant versus nonpregnant women; for example, 13.0% (95% CI, 11.0%-15.0%) of nonpregnant women had high CVH (adjusted, comparison P=0.01). Conclusions From 1999 to 2014, <1 in 10 US pregnant women, aged 20 to 44 years, had high CVH.

Keywords: Life's Simple 7; cardiovascular health; pregnancy.

Figure 1

Status of individual cardiovascular health metrics among pregnant women, aged 20 to 44 years, in the United States, 1999 to 2014*. All estimates are based on population‐weighted data from the National Health and Nutrition Examination Survey. *Body mass index (BMI) and fasting plasma glucose data are for 1999 to 2012, as month of pregnancy information was not available in 2013 to 2014. BP indicates blood pressure.

Figure 2

Prevalence of attaining individual healthy diet components among women, aged 20 to 44 years, in the United States, by A. pregnancy status and B. trimester, 1999 to 2014*. All estimates are based on population‐weighted data from the National Health and Nutrition Examination Survey. Error bars show 95% CIs. P values for comparisons between pregnant and nonpregnant women were calculated after adjustment for age and race/ethnicity. Attainment of healthy diet components for pregnant women was defined as follows: (1) fruits and vegetables: ≥4.5 cups/day; (2) fish: two to three 3.5‐oz servings/week; (3) whole grains (ie, ≥1.1 g fiber per 10 g carbohydrate): ≥3 1‐oz equivalent servings/day; (4) sodium: <1500 mg/d; (5) sugar‐sweetened beverages: ≤450 kcal/wk. See Methods text for details. *Trimester‐specific data are for 1999 to 2012, as month of pregnancy information was not available in 2013 to 2014.

Figure 3

Cardiovascular health scores among women, aged 20 to 44 years, in the United States, by pregnancy status, 1999 to 2012. All estimates are based on population‐weighted data from the National Health and Nutrition Examination Survey. Total sample sizes were 406 for pregnant women and 2563 for nonpregnant women. Comparison of mean scores by pregnancy status was adjusted for age and race/ethnicity.