Social vulnerabilities, such as lower socioeconomic status or living in a single-parent household, were associated with cardiometabolic (CM) risk factors in pregnant women in the US, according to data from a cross-sectional analysis presented at the American Heart Association (AHA) Scientific Sessions 2022, held in Chicago and virtually, November 5-7, 2022.
Approximately 700 women in the US die each year from complications of pregnancy, and 34% of these deaths are due to cardiovascular disease and stroke, according to the Centers for Disease Control and Prevention.
“Identifying and recognizing social hurdles that may be hindering health care among women, particularly pregnant women, is important to increase public health intervention efforts,” said lead author Kristen A. Harris, MD, internal medicine resident, University Hospitals Cleveland Medical Center, Ohio, in an AHA press release. “Recognizing these barriers that relate to increased risk for pregnancy-related cardiovascular disease can prompt early intervention - during pre-pregnancy planning or at the initial prenatal visits.”
“We examined cardiometabolic risk factors as opposed to cardiovascular risk factors because we are looking at the broader implications of all things that contribute to cardiac outcomes, which includes social risk factors,” added Harris.
Researchers linked natality files including all pregnancies resulting in live births in the US (aggregated 2016-2020) with county-level social vulnerability indeces (SVI), a composite metric of social risk factors with 4 major domains:
They investigated the association between SVI and its 4 subdomains with county-level prevalence of prepregnancy diabetes, prepregnancy hypertension (HTN), tobacco use, and obesity. In total, 18 953 511 pregnancies were analyzed across 577 counties.
Results showed that all 4 CM risk factors were associated with SVI and/or its 4 subdomains, and some had stronger associations than others.
Obesity was strongly associated with overall SVI (R=0.52; P<.001), with an even stronger relationship observed with socioeconomic vulnerability (R=0.6; P<.001) and household composition/disability (R=0.66; P<.001).
The rate of prepregnancy diabetes was associated with overall SVI (R=0.27; P<.001), with similar association seen with socioeconomic vulnerability (R=0.26; P<.001) and household composition/disability (R=0.28; P<.001), according to the study abstract.
Prepregnancy HTN was weakly associated with overall SVI (R=0.15; P<.001) with similar association observed with socioeconomic vulnerability (R=0.19; P<.001) and household composition/disability (R=0.22; P<.001). Tobacco use was not associated with overall SVI (R=0.034; p=0.41) but was strongly associated with minority status/language (R=-0.71; P<.001), according to investigators.
“Next steps include looking into more specific social risk factors, potentially looking into cause and effect, as well as the associations between social vulnerability and post-pregnancy complications,” stated Harris in the release. “Partnering with cardiologists to ensure a safe pregnancy and a healthy post-pregnancy period may be a way to establish earlier cardiovascular disease prevention and care and allow us to identify more easily who is at increased risk.”
Given the study’s cross-sectional design, the findings do not establish a cause-and-effect relationship between social vulnerability and CM risks in pregnancy. Among other limitations, it did not include specific social determinants of health that may also be a factor (eg, food insecurity and access to health care). In addition, the study reviewed only prepregnancy cardiovascular risks and did not include postpregnancy complications.
“Social vulnerability is playing a role in an increased prevalence of cardiometabolic and cardiovascular disease in pregnant women and in the general population,” said Harris. “This issue needs to be examined further so we may begin to understand and address these social determinants of health.”