Abstract MP67: Pre-pregnancy Cardiovascular Health And Stress Related To Severe Maternal Morbidity In Black And White Women

Abstract

Introduction: Severe maternal morbidity (SMM), unexpected complications of pregnancy with substantial consequences, are high in the U.S., contribute to maternal mortality, and racial disparities persist. Cardiovascular and psychosocial factors contribute to SMM, but pre-pregnancy risks are rarely studied. Hypothesis: Poor cardiovascular health (CVH) and adverse psychosocial stress before pregnancy contribute to SMM and racial disparities. Methods: Among 1,392 women in CARDIA (51% Black) with 2,372 post-enrollment births we characterized SMM using established criteria via delivery records (n=660 births) and self-reported hospitalizations <6-weeks postpartum (hemorrhage, sepsis, cardiomyopathy, hysterectomy) and up to 1 year post-delivery (depression, domestic violence, overdose, cardiovascular). CVH before pregnancy was quantified (BP, BMI, smoking, glucose, cholesterol, diet, activity; lower score adverse) and stress was assessed at baseline as stressful life events (higher score adverse). Self-reported adverse pregnancy outcomes (APOs) were hypertensive disorders of pregnancy, preterm birth and gestational diabetes. Generalized linear mixed models related CVH and stress to risk of SMM birth, adjusted for race, age, education, parity, APOs; non-SMM births were the referent and models were stratified by race. Results: We identified 45 SMM births (1.9%; 1.7% Black, 1.9% White); 39% at delivery and 61% post-delivery. CVH was lower and stress was higher before SMM births (9.4 [2.3] vs. 10.4 [1.9] and 8.5 [4.7] vs. 7.0 [4.1], respectively, p<0.01). Black but not White women with SMM were more likely to have poor pre-pregnancy CVH (p<0.01; Figure). Higher stress was related to SMM in Black and White women (adjusted OR per SD 1.22 [95% CI 0.92, 1.61]. Better CVH was associated with lower SMM risk in Black but not White women (0.61 [0.48, 0.78] vs. 0.93 [0.72, 1.20]). Conclusion: Poor pre-pregnancy CVH is associated with risk of SMM in Black women, and stress may be associated with SMM risk regardless of race.