Top Things to Know: Optimizing Pre-Pregnancy CV Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring
Prepared by Sally S. Wong, PhD, RD, CDN, FAHA, Senior Science & Medicine Advisor, Lead
- There is a growing burden of cardiovascular-related morbidity and mortality in pregnant and postpartum individuals in the U.S. CVD is the leading cause of death during pregnancy and the postpartum period and represents 26.5% of pregnancy-related deaths.
- Unfavorable CVH, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal CVH by race and ethnicity, socioeconomic status, and geography.
- This statement summarizes the available preclinical, epidemiological, and clinical trial evidence that support the contributions of pre-pregnancy (and inter-pregnancy) CVH to risk of adverse pregnancy outcomes and CVD in the birthing individual and offspring.
- The clinical relevance of the CVH construct as a key target in birthing individuals was recently highlighted in a joint Presidential Advisory from the AHA and the American College of Obstetricians and Gynecologists and highlights the pivotal role of primary care clinicians, pediatricians, obstetricians, and cardiologists in optimizing CVH of pregnancy-capable individuals.
- Epidemiologic studies support the association between pre-pregnancy CVH in the birthing person and offspring health outcomes, broadly termed ‘the developmental origins of health and disease.
- There are currently no large, randomized trials with sufficient power to test whether improving CVH before pregnancy will improve maternal and offspring outcomes (e.g., reduced frequency of adverse pregnancy outcomes (APOs), severe maternal morbidity, maternal mortality). Available data rely on studies that have intervened on single risk factors, such as weight loss to reduce gestational diabetes risk, rather than comprehensive CVH promotion.
- Psychological health, stress, and resilience are inextricably linked with CVH and are identified as foundational determinants in optimizing CVH by the AHA.
- To achieve health equity among birthing individuals, attentive design of community-based interventions is crucial and will require community-centered engagement at every stage of the research process.
- Making ideal CVH the social norm in a community can be achieved with the integration of equitable opportunities to maintain healthier lifestyle practices, such as increasing access to healthier and affordable foods, greener and walkable neighborhoods, free or subsidized fitness center memberships, and safe and proximate parks and recreational facilities.
- Lastly, effective interventions should consider multi-level approaches at the individual-, community-, and societal-level. The pre-pregnancy period offers a unique window of opportunity to address the growing public health burden of APOs and interrupt the intergenerational transmission of poor CVH.
Citation
Khan SS, Brewer LC, Canobbio MM, Cipolla MJ, Grobman WA, Lewey J, Michos ED, Miller EC, Perak AM, Wei GS, Gooding H; on behalf of the American Heart Association Council on Epidemiology and Prevention; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council. Optimizing prepregnancy cardiovascular health to improve outcomes in pregnant and postpartum individuals and offspring: a scientific statement from the American Heart Association [published online February 13, 2023]. Circulation. doi: 10.1161/CIR.0000000000001124