Study Links Socioeconomic Status in Early Pregnancy to Long-Term Heart Health Disparities

A new study presented at the American Heart Association's Scientific Sessions 2024 reveals that socioeconomic status during early pregnancy may play a significant role in explaining cardiovascular health disparities among women of different racial and ethnic groups up to seven years after giving birth. The research, which examined over 4,000 first-time mothers, found that factors such as education level, income, health insurance status, and health literacy accounted for more than half of the long-term heart health differences observed between Black, Hispanic, and white women.

The study utilized data from the nuMoM2b-HHS research project to calculate cardiovascular health scores for participants based on the American Heart Association's Life's Essential 8 metrics. These metrics include body mass index, blood pressure, cholesterol, blood sugar, diet, physical activity, sleep health, and smoking status. Researchers then used statistical modeling to estimate how demographic, socioeconomic, and psychosocial factors during early pregnancy affected these heart health scores years later.

The analysis revealed striking disparities, with white mothers scoring an average of 12.2 points higher than Black mothers and 3.3 points higher than Hispanic mothers on the cardiovascular health scale. However, when socioeconomic data for Black women was adjusted to match their white counterparts, their cardiovascular health scores increased by 6.6 points, effectively eliminating more than 50% of the observed difference. For Hispanic women, a similar adjustment completely erased the gap in cardiovascular health scores compared to white women.

These findings underscore the critical importance of addressing social determinants of health in maternal care. The research suggests that improving access to education, increasing income levels, expanding health insurance coverage, and enhancing health literacy could significantly reduce cardiovascular health disparities among women of different racial and ethnic backgrounds.

The study's implications extend beyond individual health outcomes, pointing to broader systemic issues in healthcare and social policy. As the United States grapples with a rising maternal death rate – unique among developed nations – these results highlight the urgent need for public health policies that address the impact of structural racism on maternal health and healthcare access.

Recent efforts to expand Medicaid coverage for postpartum care from 60 days to one year in 47 states and the District of Columbia represent a step in the right direction. However, the study's authors argue that more comprehensive measures are needed to promote health equity throughout pregnancy and beyond.

Dr. Vesna D. Garovic, an American Heart Association volunteer expert, emphasized the importance of these findings, stating, "Identifying the role of socioeconomic status in postpartum cardiovascular health provides supporting data to augment affordable preventive postpartum care, such as extending Medicaid postpartum coverage to one year."

While the observational nature of the study means it cannot establish direct cause and effect relationships, the strong associations observed between socioeconomic factors and cardiovascular health outcomes cannot be ignored. The research team acknowledges that other factors, such as hypertensive disorders of pregnancy and gestational diabetes, which were not included in the analysis, may also influence cardiovascular health after pregnancy.

As the scientific community continues to produce evidence highlighting the importance of social determinants of health, policymakers and healthcare providers must take action to address these disparities. Expanding access to affordable healthcare, improving economic opportunities, and implementing targeted interventions for at-risk populations could have far-reaching effects on maternal health outcomes and reduce the burden of cardiovascular disease among women of all backgrounds.

The findings from this study serve as a call to action for healthcare systems, policymakers, and society at large to address the root causes of health disparities and work towards a more equitable future for maternal health. By focusing on socioeconomic factors during pregnancy, we may be able to significantly improve long-term cardiovascular outcomes and reduce the persistent health gaps that have long plagued our healthcare system.