Area deprivation, social vulnerability, and post-pregnancy blood pressure

Pregnancy is a critical test of women's cardiovascular risk. Structural factors may influence long-term cardiovascular health beyond individual, social experiences. We examined associations of neighborhood-level deprivation and individual-level social vulnerability (SV) during pregnancy with postpartum blood pressure (BP).

This secondary analysis of a prospective cohort study used data from 3,728 nulliparous women in the nuMoM2b-HHS cohort followed from early pregnancy to 2-7 years post-delivery (Mage: 30.8 years, 65% non-Hispanic White, 14% with adverse pregnancy outcomes [APOs]). Multivariable linear and logistic regression models tested relations of the Area Deprivation Index (ADI) and SV (a composite of perceived stress, discrimination, pregnancy experiences, social support, health literacy, depression, and anxiety) with systolic BP (SBP), diastolic BP (DBP), and incident hypertension, adjusting for demographic and behavioral covariates. Effect modification by APO history was assessed.

In unadjusted models, both ADI and greater SV were positively associated with SBP and DBP (all ps<0.001). After adjustment, ADI remained positively associated with BP: each 10-unit increase in ADI was associated with 1.0 mmHg higher SBP (p=0.008) and 0.6 mmHg higher DBP (p=0.013). However, SV was no longer associated with BP after adjustment. ADI and SV were not associated with incident hypertension. No evidence of effect modification by APO history was observed (interactions p>0.20).

Neighborhood deprivation during pregnancy was associated with higher BP up to seven years later, independent of individual social vulnerability. Structural context during pregnancy may contribute to early maternal cardiovascular risk.