Abstract 053: Association Of Pre-pregnancy Cardiovascular Health With Adverse Maternal And Fetal Outcomes

Abstract

Introduction: Individual pre-pregnancy risk factors such as obesity, hypertension, and diabetes disproportionately affect minority women and are associated with adverse maternal and offspring outcomes. However, quantification of pre-pregnancy cardiovascular health (CVH) and association with pregnancy outcomes is lacking and can help identify at-risk women and children. Hypothesis: Suboptimal pre-pregnancy CVH is associated with higher risk of adverse maternal and fetal outcomes. Methods: We conducted a cross-sectional study using the CDC Natality files, which include all pregnancies in the US that resulted in live birth or fetal death after 20 weeks. Our study sample consisted of data from singleton live births or fetal deaths to women aged 15-44 years in 2018. Four maternal metrics (body mass index, smoking, diabetes, and hypertension) were assigned 1 point each for pre-pregnancy BMI < 25.0 kg/m 2 , non-smoking, and absence of hypertension or diabetes to construct a pre-pregnancy clinical CVH score ranging from 0-4. We examined the distribution of CVH by race/ethnicity. We then quantified associations of CVH with maternal ICU admission, preterm birth (PTB), low birthweight (LBW), and fetal death using logistic regression (CVH = 4 as the referent) adjusted for maternal age, race/ethnicity, education, prenatal care, and parity. Results: Of 3,582,832 pregnancies in 2018, more than half of women had a suboptimal CVH score (CVH = 3: 51.8%; CVH = 2: 6.7%; CVH = 0/1: 0.4%). Suboptimal CVH score (<4) was more prevalent in non-Hispanic Black (67.8%) and Hispanic (63.1%) than in non-Hispanic White (57.2%) and Asian (36.8%) women ( Figure) . There were consistent and inverse graded associations between CVH score of 3, 2, and 0/1 (compared with 4 as the referent) and maternal ICU admission, PTB, LBW, and fetal death (p<0.001). Conclusions: Pre-pregnancy clinical CVH score has strong, graded associations with adverse maternal and fetal outcomes, with disproportionate impact of suboptimal CVH in non-Hispanic Black and Hispanic women.