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More Than Half of U.S. Women Have Poor Heart Health Before Pregnancy

According to the National Institutes of Health, National Heart, Lung, and Blood Institute, and American Heart Association (AHA), only about two-thirds of U.S. women who gave their births in 2019 were in good health. Obesity and overweight are the main risk factors. The journal Circulation published their findings on February 14.

“”Being in good health prior to pregnancy benefits the long-term health of women and their children,”” said the lead study author, Natalie A. Cameron, MD, an internal medicine specialist and instructor at Northwestern University’sUniversity’s Feinberg School of Medicine in Chicago, in a press release.

“”Unfortunately, these findings about the number of women with poor heart health prior to pregnancy are not surprising — heart disease is the leading cause of death for women in the U.S.,”” says Rachel Urrutia, MD, an obstetrician-gynecologist and an assistant professor at the UNC School of Medicine in Chapel Hill, North Carolina, who was not involved in the research.

Dr. Urrutia says that obesity and overweight are both cardiovascular risk factors in this study. These rates are on the rise.

The prevalence of obesity among U.S. adults rose from 30.5 percent in 1999-2000 to 42.4 percent between 2017-2018 and National Health and Nutrition Examination Surveys (NHANES).

The number of women with good heart health has declined

To examine the prevalence of prepregnancy heart risk in the United States and compare geographic regions, investigators used data from the Centers for Disease Control and Prevention’sPrevention’s Natality Database from 2016-2019. The total number of live births in the United States was 14,174,625. Women were aged between 20-44 years, and 81.4 percent were between 20-34.

This group included 52.7 percent non–Hispanic whites, 22.7 percent Hispanic/Latinas, and 14% non-Hispanic Blacks. A normal body weight and a BMI between 18 and 24.9 was considered optimal heart health.

Researchers discovered the following trends:

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  • The percentage of women who have optimal pre-pregnancy heart health has fallen more than 3 percent from 43.5 to 40.2 percent between 2016 and 2019.
  • Heart health has declined on average in older women. In 2019, 37.1 percent of women aged 40-44 had good heart health, and 42.2 percent for women aged 30 to 34.
  • Before becoming pregnant, more than half of women had at least 1 risk factor for developing cardiovascular disease. Before Pregnancy, the leading cause of poor heart health was being overweight or obese.

The South and Midwest had lower percentages of women in good pregnancies heart health.

Researchers compared data by geographic regions to find that the South and Midwest had the lowest levels of good heart health at 38.1 percent and 38.8 respectively. The highest rates of good heart health were found in the Northeast and West at 42.2 percent each.

Researchers suspect that these geographic differences are largely caused by socio-economic determinants of healthcare, such as educational status, Medicaid enrollment and access to preventive health care.

“”These geographic patterns are, unfortunately, very similar to what we see for heart disease and stroke in both men and women, and they indicate that social determinants of health play a critical role in maternal heart health as well,”” said the senior study author, Sadiya S. Khan, MD, an assistant professor of medicine in the division of cardiology at Northwestern University’sUniversity’s Feinberg School of Medicine in Chicago, in the release.

A poor maternal heart health can lead to poor outcomes for both mom and baby

“Pregnancy is nature’snature’s stress test. There are many changes in the body during Pregnancy, particularly the heart, including increased blood circulation, that put an extra burden on a woman’swoman’s heart,”” said a coauthor of the American Heart Association’sAssociation’s Scientific Statement on Cardiovascular Consideration in Caring for Pregnant Patients, Garima V. Sharma, MBBS, the director of cardio-obstetrics and an assistant professor of medicine at Johns Hopkins School of Medicine in Baltimore, who was not involved in this study, in the release.

Dr. Sharma stated that “making sure you’re in good health before you get pregnant will ensure you have the best possible pregnancy outcomes.”

Poor heart health puts both mothers-to-be and their children at risk, with heart disease causing more than one in four pregnancy-related deaths (26.5 percent) according to the American Heart Association’sAssociation’s Heart Disease and Stroke Statistics 2022 Update.

According to a November 2020 report by the Commonwealth Fund (a private foundation that aims to improve access and quality for our most vulnerable citizens), the United States has the highest maternal death rate of all 11 developed countries. According to the authors, the maternal mortality rate in 2018 was 17.3 deaths per 100,000 live births. This is more than twice that of other high-income countries.

“We have higher rates of obesity, diabetes, and chronic hypertension than other countries. This can certainly have an effect on the greater incidence for maternal death,” says Shari Martin, MD, division director of general and gynecology, as well as an assistant professor of gynecology at Johns Hopkins Medicine in Baltimore.

Urrutia says that poor maternal health can also lead to poor outcomes for babies born. “For example, we know that babies born to women with PCOS (polycystic-ovary syndrome), are more likely to develop insulin resistance. She says that while some of this may be genetic, others could be due to in utero factors.

PCOS can be caused by an imbalance in reproductive hormones, which causes problems in the ovaries. According to the Office on Women’sWomen’s Health, PCOS is associated with high blood pressure, diabetes, high cholesterol (bad), and low HDL(good) cholesterol.

Support and Policies Needed to Improve Women’s Pregnancy Health

The impact of poor heart health upon the outcomes of both mother and child is clear.

Dr. Khan stated that the conversation should shift from ”what women can do” to ”what society can do to support pregnant individuals'”. “We need state and federal public health policies to ensure that women have equal access to healthcare before, during and after pregnancy. Also, economic investment in communities is needed to encourage healthy behavior such as exercise and accessing heart-healthy foods. “”

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