Trends in Prepregnancy Cardiometabolic Health in Rural and Urban Areas in the United States, 2016-2023

Objectives. To describe differences in prepregnancy cardiometabolic health in the United States by urbanicity from 2016 to 2023. Methods. We included 29 087 432 pregnant individuals 15 to 44 years old with data in the Centers for Disease Control and Prevention Natality Files. We calculated age-standardized trends in prepregnancy cardiometabolic health from 2016 to 2023 by urbanicity using the cardiovascular-kidney-metabolic (CKM) staging system (stage 0 [no risk factors], stage 1 [overweight/obesity], and stage 2 [diabetes or hypertension]). We used prevalence ratios to compare annual prevalence by urbanicity. Results. From 2016 to 2023, the prevalence of prepregnancy CKM stage 0 decreased in rural and urban areas, whereas the prevalence of stages 1 and 2 increased. Specifically, stage 0 decreased from 41.5% (95% confidence interval [CI] = 41.4%, 41.7%) to 35.6% (95% CI = 35.4%, 35.7%) in rural areas and from 48.2% (95% CI = 48.1%, 48.3%) to 40.7% (95% CI = 40.6%, 40.7%) in urban areas. Prevalence ratios for stages 0 through 2 in 2016 were 0.86 (95% CI = 0.86, 0.87), 1.12 (95% CI = 1.11, 1.12), and 1.36 (95% CI = 1.34, 1.39), respectively, in rural relative to urban areas and remained stable over the study period. Conclusions. In this national sample, prepregnancy cardiometabolic health decreased from 2016 to 2023 in urban and rural communities and exhibited a persistent gap, with rural areas more severely affected. (Am J Public Health. 2026;116(3):372-375. https://doi.org/10.2105/AJPH.2025.308299).