Socioeconomic status during early pregnancy could predict cardiovascular health later in life

A preliminary study that will be presented at the American Heart Association’s (AHA) Scientific Sessions 2024 from November 16-18, 2024, in Chicago, found socioeconomic status during early pregnancy to be a predictor of cardiovascular health years later. The research determined that the socioeconomic status of first-time mothers could explain many of the disparities in the cardiovascular health of different racial and ethnic groups of women, two to seven years after giving birth.

“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,” Xiaoning “Jack” Huang, PhD, first author of the study and research assistant professor of medicine at Northwestern University’s Feinberg School of Medicine, said in a news release. “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.”

4,161 first-time mothers in their first trimester of pregnancy women took part in the study, which examined the effect of social determinants of health (SDOH) in early pregnancy among Black, Hispanic and white women. Researchers used the AHA’s Life’s Essential 8 score, which considers diet, physical activity, sleep smoking status, blood sugar, blood pressure, cholesterol and body mass index, to assign scores to the first-time mothers, assessing the effect of demographics, socioeconomic status and psychosocial health, two to seven years later.

According to their analysis, the average cardiovascular health score of white mothers was significantly higher than Black and Hispanic mothers, by 12.2 points and 3.3 points, respectively. Further, researchers found socioeconomic status during early pregnancy to have the greatest impact on heart health scores, compared to demographics and psychosocial health. In support of this, when they adjusted the socioeconomic data of Black mothers to match that of white mothers, cardiovascular scores of Black mothers increased by 6.6 points, effectively removing more than 50% of the health disparity between the groups. When the same adjustment was made for Hispanic mothers, their scores improved by 3.9 points, entirely erasing the score gap and cardiovascular health disparity between the groups.

“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.”

Demographics, socioeconomic status and psychosocial health factors were considered in the researchers’ analysis of the women. Specifically, they examined how age, ethnicity, education, income, access to health insurance, health literacy, resilience, social support, depression, anxiety and stress levels of women in early pregnancy had on their later cardiovascular health.

“This data is critically needed,” explained Vesna D. Garovic, MD, PhD, AHA volunteer expert, 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. Identifying the role of socioeconomic status in postpartum cardiovascular health provides supporting data to augment affordable preventative postpartum care, such as extending Medicaid postpartum coverage to one year.”

Garovic stressed the importance of these findings, saying, “the United States is the only developed country with an increasing maternal death rate. Poor care before, during and after 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, the findings of the study support enhancing the accessibility and affordability of health care in support of people, and specifically first-time mothers, who are more socioeconomically disadvantaged to receiving the preventative care they require.

“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.”