GREENVILLE, SOUTH CAROLINA — A cohort study published in JAMA Network Open found that higher cardiovascular health scores during pregnancy were associated with a delayed onset of chronic hypertensive and metabolic conditions over a seven-year postpartum period. Each 10-point increase in a modified pregnancy-specific heart-health checklist score was linked to a longer time before diagnosis of these conditions.

Ellen Francis, a researcher from the Rutgers School of Public Health, and her colleagues reported that each 10-point increase in the modified "Life's Essential 8" (mLE8) score was linked to a time ratio of 1.26 for incident chronic hypertensive conditions and a time ratio of 1.20 for incident chronic metabolic conditions. The mLE8 is a 100-point scale where higher scores indicate better health, adapted from the American Heart Association's checklist. This framework includes factors such as hypertensive disorders of pregnancy, results from a 50-g glucose tolerance test, early pregnancy body mass index (BMI), smoking status, sleep adequacy, diet quality, and physical activity.

The analysis involved 1,225 pregnancies from a cohort study conducted at a large academic medical system in Greenville, South Carolina. Participants were individuals aged 14 to 45 with a singleton pregnancy who had not yet delivered and were enrolled from the Cradle randomized trial. Patients with pre-existing diabetes or cardiovascular disease were excluded. Demographic, lifestyle, and stress surveys were completed at enrollment, around 20 weeks' gestation, and again during the third trimester. Blood samples were collected during the second trimester for testing.

Participants were followed for seven years postpartum through electronic medical record surveillance, with follow-up beginning seven days after delivery or on the expected delivery date for those who miscarried or missed their delivery date. The follow-up period extended from August 2018 to March 2026. Over a median follow-up of 6.2 years, 499 incident cardiometabolic events were recorded.

Francis stated that cardiovascular health assessment during pregnancy helps identify those at greatest risk, but also those with "latent risk or subclinical vulnerability." She noted that "Poorer cardiovascular health was associated with subsequent hypertensive and metabolic conditions even among women without gestational diabetes or a hypertensive disorder of pregnancy." Francis added that "A broader assessment could potentially identify additional women who may benefit from prevention and health-promotion services after delivery." She also indicated that factors like diet, physical activity, and sleep are not assessed consistently in routine prenatal care.

The study found that longer time to diagnosis of chronic metabolic conditions was associated with better component scores for hypertensive disorders of pregnancy (1.06 per 10-point increase), glucose (1.15 per 10-point increase), BMI (1.07 per 10-point increase), and sleep (1.05 per 10-point increase). Associations for smoking, physical activity, and diet were not found to be statistically significant. The authors stated that the lack of significance for smoking, physical activity, and diet should be interpreted cautiously given the strong evidence base connecting these factors to adverse cardiovascular outcomes.

The authors acknowledged limitations in the study, including that diagnosis dates in electronic medical records might not reflect the true biological onset of conditions. They also noted that participants who delivered later in the study had less observable follow-up time, and there was a possible misclassification of self-reported outcomes. The researchers stated that validation studies are needed, as is further research into how to translate these assessments into improved health outcomes through specific interventions. Francis suggested that "Extended postpartum Medicaid coverage could provide a greater window in which women identified as having poorer cardiovascular health during pregnancy can receive follow-up, risk-factor management, and referrals to prevention services."