Impact of Social Determinants of Health in Early Pregnancy on Racial and Ethnic Differences in Post-pregnancy Cardiovascular Health
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Background
Social determinants of health (SDOH) influence maternal cardiovascular health (CVH), but the extent to which SDOH in early pregnancy may explain racial and ethnic differences in post-pregnancy CVH has not been defined.
Methods
This secondary analysis used data from the prospective multisite Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study. CVH was assessed in early pregnancy and 2-7 years after delivery using the American Heart Association’s Life’s Essential 8 (LE8) framework. We used the Oaxaca-Blinder decomposition to quantify the statistical contributions of differences in early pregnancy CVH, SDOH, psychosocial factors, and demographic covariates to racial and ethnic differences in post-pregnancy CVH between the two largest minoritized racial and ethnic groups (non-Hispanic [NH] Black and Hispanic) compared with NH White women.
Results
Among 4,088 women (14.4% Black, 17.6% Hispanic, and 68.0% White), the mean (SD) post-pregnancy LE8 score was lower in Black (70.1 [14.1]) and Hispanic (77.8 [12.7]) women compared with White women (82.4 [12.7]) (all p<0.01). Independent of early pregnancy CVH, maternal age, and nativity, differences in SDOH were associated with 4.5 (95% CI, 2.8-6.2) points of the Black-White gap (37% of the observed post-pregnancy CVH difference) and 3.2 (95% CI, 1.1-5.3) points of the Hispanic-White gap (70% of the observed post-pregnancy CVH difference), respectively.
Conclusions
Most racial and ethnic differences in post-pregnancy CVH 2 to 7 years after a first birth were explained by differences in early pregnancy CVH and SDOH. Independent of early pregnancy CVH, SDOH remained the largest measured contributor to the residual difference.
CLINICAL PERSPECTIVE
What Is New?
Among 4,088 women followed 2 to 7 years after a first birth, differences in early pregnancy social determinants of health and cardiovascular health together accounted for approximately three-quarters of the racial and ethnic differences in post-pregnancy cardiovascular health.
What Are the Clinical Implications?
Because differences in cardiovascular health persisted beyond what differences in measured social risk factors explained, social risk screening in early pregnancy should be paired with sustained cardiovascular follow-up after delivery rather than treated as sufficient on its own. Black women did not experience the improvements in physical activity and smoking cessation seen in other groups after a first birth, identifying the postpartum period as a window for behavioral cardiovascular risk reduction.
