Socioeconomic disadvantage in pregnancy linked to postpartum CVD risk

Socioeconomic disadvantage in pregnancy linked to postpartum CVD risk | Image Credit: © alenamozhjer - © alenamozhjer - stock.adobe.com.

The risk of postpartum cardiovascular disease (CVD) is increased in women with neighborhood-level socioeconomic disadvantage in early pregnancy, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

CVD accounts for approximately 1 in 5 deaths in US women, making it the leading cause of mortality in this population. Women face unique risk factors of CVD compared to men, including certain adverse pregnancy outcomes. Additionally, pregnant women face widening disparities that may impact health outcomes.²

A link has been established between adverse social determinants of health (SDOH) and CVD risk.¹ According to investigators, since pregnant patients often seek preventive care, “the pregnancy and the postpartum period are particularly valuable windows to assess both SDOH and CVD risk.”

The study was conducted to determine the 30-year CVD risk in patients increases based on a risk score combining multiple social determinants. The Area Deprivation Index (ADI) was the primary measure of determinants, and data was obtained from the Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be (nuMoM2b) study.

Nulliparous pregnant patients were enrolled in the nuMoM2b study from 2010 to 2013. ADI data was obtained during a study visit conducted between 6- and 13-weeks’ gestation, while predicted CVD risk was determined during a visit 2 to 7 years after delivery.

Participants included women with a singleton pregnancy at 6- to 13-weeks’ gestation, no prior delivery before 20-weeks’ gestation, and intension to deliver at a study hospital. Those with donor oocyte pregnancy, lethal fetal malformations, planned pregnancy termination, 3 or more prior pregnancy terminations, or fetal aneuploidy were excluded.

Neighborhood socioeconomic deprivation was the primary outcome of the analysis, measured using the ADI. ADI domains include income, education, employment, and housing quality. Scores range from 0 to 100, with higher scores indicating increased disadvantage. Participants provided their home address at the first study visit for ADI calculation.

The predicted 30-year risk of atherosclerotic cardiovascular disease (ASCVD) was the primary outcome of the analysis, determined using the Framingham Risk Score. The total CVD risk score was also reported as a primary outcome, measured between 2 and 7 years following delivery.

CVD risk factors included in the measurement included age in years, sex, total cholesterol, high density lipoprotein cholesterol, current smoking status, systolic blood pressure, treatment with an antihypertensive medication, and diabetes. The Framingham Risk Score combined these risk factors in algorithms to determine a patient’s risk.

There were 4309 patients included in the final analysis, with a median overall ADI score of 43, vs 14 for the least deprived tertile (T1), 40 for the middle tertile, and 86 for the most deprived tertile (T3). Patients with ADI were more likely to present with diabetes, hypertension, and an increased body mass index.

A median 30-year predicted risk for ASCVD of 2.3% was reported during the follow-up at 2 to 7 years postpartum, vs 5.5% for total CVD. These rates varied based on baseline comorbidities and individual-level SDOH.

The absolute risk percent of 30-year ASCVD was highest in T3 patients, with a 95% confidence interval of 0.19, 0.63 compared to T1 patients. Having a predicted risk of ASCVD of 10% or higher was also more common in T3 patients vs T1 patients, with an adjusted risk ratio (aRR) of 2.21. For total CVD of 10% or higher, the aRR was 1.35.

These results indicated increased risk of CVD among patients with neighborhood-level socioeconomic disadvantage early in pregnancy. Investigators concluded “these data add to a growing public health recognition of the importance of the SDOH in pregnancy as an important determinant of future maternal cardiovascular health.”

References

1. Venkatesh KK, Khan SS, Catov J, et al. Socioeconomic disadvantage in pregnancy and postpartum risk of cardiovascular disease. Am J Obstet Gynecol. 2025;232:226.e1-14. doi:10.1016/j.ajog.2024.05.007
2. Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, Wallace M. Social and structural determinants of health inequities in maternal health. J Womens Health (Larchmt). 2021;30(2):230-235. doi:10.1089/jwh.2020.8882