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Lower Prepregnancy Cardiovascular Health is Associated With Hypertensive Disorders of Pregnancy: The CARDIA Study

L V Dodds1, D J Feaster1,2, C I Kiefe3

  • 1Department of Public Health Sciences (L.V.D., D.J.F.), University of Miami Miller School of Medicine, Miami, FL.

Hypertension (Dallas, Tex. : 1979)
|August 8, 2025
PubMed

Insights

Lower prepregnancy cardiovascular health, measured by the Life's Essential 8 (LE8) score, is linked to a higher risk of hypertensive disorders of pregnancy (HDP). Improving cardiovascular health before pregnancy may reduce HDP incidence.

Area of Science:

  • Cardiovascular Health
  • Obstetrics
  • Public Health

Background:

  • Hypertensive disorders of pregnancy (HDP) increase maternal morbidity, mortality, and long-term cardiovascular disease risk.
  • The origin of HDP, whether from pregnancy complications or pre-existing traits, remains unclear.
  • Assessing pre-pregnancy cardiovascular health using the American Heart Association's Life's Essential 8 (LE8) score may clarify HDP risk factors.

Purpose of the Study:

  • To evaluate the association between pre-pregnancy cardiovascular health, as assessed by the LE8 score, and the risk of developing HDP.
  • To determine if cardiovascular health metrics before pregnancy are independent predictors of HDP.

Main Methods:

  • Utilized data from the Coronary Artery Risk Development in Young Adults (CARDIA) study (n=5115).
  • Calculated the LE8 score (0-100) based on diet, smoking, physical activity, sleep, BMI, blood pressure, cholesterol, and glucose.
  • Analyzed the association between LE8 categories (low, moderate, high) and HDP (gestational hypertension, preeclampsia, eclampsia) in 2036 pregnancies using generalized mixed models.

Main Results:

  • Women who developed HDP had lower mean baseline LE8 scores (77.0) compared to those without HDP (79.5).
  • Moderate (OR=1.78) and low (OR=3.95) pre-pregnancy cardiovascular health were significantly associated with increased HDP risk compared to high cardiovascular health.
  • The findings were adjusted for various demographic and pregnancy-related factors.

Conclusions:

  • Lower pre-pregnancy cardiovascular health is an independent risk factor for hypertensive disorders of pregnancy.
  • Interventions aimed at improving cardiovascular health prior to pregnancy could potentially mitigate HDP risk.
  • Public health initiatives focusing on cardiovascular wellness may play a role in reducing adverse pregnancy outcomes.
Abstract

Keywords:
cardiovascular diseasescardiovascular healthhypertension, pregnancy-inducedpreconceptionpreeclampsiaprepregnancy

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