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Observational Study
. 2025 Oct;82(10):1696-1704.
doi: 10.1161/HYPERTENSIONAHA.124.24517. Epub 2025 Aug 8.

Lower Prepregnancy Cardiovascular Health is Associated With Hypertensive Disorders of Pregnancy: The CARDIA Study

Leah V Dodds  1 , Daniel J Feaster  1   2 , Catarina I Kiefe  3 , Erica P Gunderson  4 , Natalie A Bello  5 , Tatjana Rundek  6 , Michael J Paidas  7 , Shathiyah Kulandavelu  8 , Tali Elfassy  9
Affiliations
Observational Study

Lower Prepregnancy Cardiovascular Health is Associated With Hypertensive Disorders of Pregnancy: The CARDIA Study

Leah V Dodds et al. Hypertension. 2025 Oct.

Abstract

Background: Hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia, and eclampsia, contribute to increased maternal morbidity and mortality and long-term cardiovascular disease risk. It is unclear whether HDP arises from pregnancy-specific complications or preexisting maternal cardiovascular traits unmasked during pregnancy. This article evaluates whether cardiovascular health before pregnancy, assessed by the American Heart Association's Life's Essential 8 (LE8) score, is associated with HDP risk.

Methods: The CARDIA (Coronary Artery Risk Development in Young Adults) is a longitudinal cohort study of 5115 Black and White men and women, aged 18 to 30 years at baseline (1985-1986), and followed for over 30 years (nBlackWomen=1480; nWhiteWomen=1307). The LE8 score (range, 0-100) was calculated using health behaviors (diet, smoking, physical activity, sleep) and clinical metrics (body mass index, blood pressure, cholesterol, glucose). Cardiovascular health was categorized as low (LE8 <50), moderate (LE8 50-79), or high (LE8 ≥80). HDP was self-reported as gestational hypertension, preeclampsia, or eclampsia in pregnancies lasting ≥23 weeks. Generalized mixed models assessed the association between LE8 and HDP among 2036 pregnancies from 1227 women, adjusting for age, time-varying parity, education, income, follow-up time, cumulative births, and multiple gestation.

Results: Mean baseline age was 24.1 years, 48.7% were Black women, and 19.9% reported HDP. Women with HDP had lower baseline LE8 scores (77.0 versus 79.5; P<0.01). Compared with high cardiovascular health, moderate (odds ratio, 1.78 [95% CI, 1.13-2.81]) and low cardiovascular health (odds ratio, 3.95 [95% CI, 1.05-14.88]) were associated with increased HDP risk.

Conclusions: Lower prepregnancy cardiovascular health is an independent risk factor for HDP. Improving cardiovascular health may reduce HDP risk.

Keywords: cardiovascular diseases; cardiovascular health; hypertension, pregnancy-induced; preconception; preeclampsia; prepregnancy.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Differences in LE8 scores were significicantly different at all exam years, p<0.001
See this image and copyright information in PMC

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