Association Between Social Determinants of Health and Cardiovascular Risk in Pregnant Women, United States

Poor cardiovascular health (CVH) accounts for one-third of pregnancy-related deaths in the US. Social determinants of health (SDOH) - conditions in which people are born, grow, work, live, and age - can negatively influence maternal CVH. Little is known about potential negative effects of SDOH on CVH during the perinatal period. This study aimed to identify associations between SDOH with CVH in pregnant women.

We conducted a cross-sectional analysis of women who participated in the Pregnancy Risk Assessment and Monitoring System (PRAMS) survey between 2016 and 2020. We created a composite score for CVH status based on the presence of hypertension, diabetes, smoking, and obesity. SDOH variables were maternal education level, marital status, rural residency, work status, poverty level, insurance status, food security, history of breastfeeding, birth order of the child, history of abuse, and depression history. Logistic regression accounting for complex survey data evaluated the association of SDOH with poor CVH risk by using adjusted odds ratios (AORs) and 95% CIs.

The final sample was 205,513 pregnant women (57.2% non-Hispanic white, 15.1% non-Hispanic Black, 18.3% Hispanic), of whom 53.8% were classified as having poor CVH. Disadvantaged SDOH were associated with poor CVH: rural residence (OR = 1.15), food insecurity (OR = 1.36), abuse history (OR = 1.43), depression history (OR = 1.52), living at or below the federal poverty line (OR = 1.23), single marital status (OR = 1.38), less than high school diploma (OR = 1.13) and having government insurance (OR = 1.31) (all P < .05).

Having disadvantaged SDOH was associated with poor CVH during pregnancy.