Association of neighborhood-level socioeconomic disadvantage and Life's Essential 8 in early pregnancy

Kartik K Venkatesh; William A Grobman; Xiaoning Huang; Lynn M Yee; Janet Catov; Hy Simhan; David M Haas; Brian Mercer; Uma Reddy; Robert M Silver; Lisa D Levine; Judith Chung; George Saade; Philip Greenland; C Noel Bairey Merz; Becky McNeil; Sadiya S Khan

doi:10.1016/j.ajpc.2024.100925

Association of neighborhood-level socioeconomic disadvantage and Life's Essential 8 in early pregnancy

Am J Prev Cardiol. 2024 Dec 24:21:100925. doi: 10.1016/j.ajpc.2024.100925. eCollection 2025 Mar.

Authors

Kartik K Venkatesh¹, William A Grobman¹, Xiaoning Huang², Lynn M Yee³, Janet Catov⁴, Hy Simhan⁴, David M Haas⁵, Brian Mercer⁶, Uma Reddy⁷, Robert M Silver⁸, Lisa D Levine⁹, Judith Chung^{10

11}, George Saade¹², Philip Greenland², C Noel Bairey Merz¹³, Becky McNeil¹¹, Sadiya S Khan²

Affiliations

¹ Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA.
² Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.
³ Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA.
⁴ Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA.
⁵ Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA.
⁶ Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA.
⁷ Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA.
⁸ Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
⁹ Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA, USA.
¹¹ RTI International, Durham, NC, USA.
¹² Department of Obstetrics and Gynecology, Eastern Virginia Medical College, Norfolk, VA, USA.
¹³ Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.

Abstract

We examined whether neighborhood-level socioeconomic disadvantage per the Area Deprivation Index (ADI) was associated with maternal cardiovascular health (CVH) in early pregnancy per the American Heart Association Life's Essential 8 (LE8). This is a cross-sectional analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study (nuMoM2b-HHS) cohort. The exposure was the ADI in tertiles (T) from least (T1) to most (T3) socioeconomic disadvantage. The outcome was the LE8 as a continuous score ranging from worst (0) to best (100) composite CVH; and included physical activity, diet quality, tobacco use, sleep quantity, body mass index, blood pressure, glucose, and lipid levels. Among 4,508 nulliparous individuals at a mean maternal age of 27.0 years (SD: 5.6) and at a mean gestational age of 11.4 weeks (SD 1.6), the mean ADI was 48.0 (SD: 30.4) and the mean LE8 was 80.3 (SD: 12.5). Pregnant individuals living in neighborhoods with greater socioeconomic disadvantage had lower mean LE8 scores (i.e., worse CVH) compared with those living in neighborhoods with lesser disadvantage (T1 vs. T2 adjusted mean: 82.6 vs. 80.5; adj. ß:2.08; 95 % CI:3.51, -0.64; and T1 vs. T3 adjusted mean: 82.6 vs. 77.8; adj. ß:4.77; 95 % CI:8.16, -1.38). Neighborhood-level socioeconomic disadvantage was associated with worse maternal CVH in early pregnancy.

Keywords: Area deprivation index; Cardiovascular health; Life's Essential 8; Pregnancy; Social determinants of health.