Abstract
Introduction: To determine whether residing in a more socioeconomically deprived area during early pregnancy is associated with worse maternal cardiovascular health (CVH), as quantified by the American Heart Association Life’s Essential 8 (LE8). Methods: Secondary analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study cohort. Participant home addresses in the first trimester were geocoded at the census-tract level. The exposure was neighborhood-level area deprivation index (ADI), categorized by tertile (least deprived [T1], reference; most deprived [T3]). The outcome was CVH defined by the LE8 assessed in the first trimester, which includes physical activity, diet quality, tobacco use, sleep quantity, body mass index (BMI), blood pressure, and serum fasting glucose and lipid levels to create a score ranging from 0 to 100 (higher being better). Multivariable linear regression models were used to examine associations between ADI tertile and CVH scores for each component and a summary CVH score. Results: In this cohort of nulliparous individuals in the first trimester, the mean ADI was 45.2 (SD: 30.7), and the mean overall LE8 was 82.2 (SD: 12.0). Compared with those with the least neighborhood disadvantage (i.e., T1), individuals living in neighborhoods with greater neighborhood disadvantage had lower mean LE8 scores, indicating worse CVH (T1 vs. T2 adjusted mean: 84.68 vs. 81.75; adj. ß: -2.92; 95% CI: -4.19, -1.66; and T1 vs. T3: 84.68 vs. 79.15; adj. ß: -5.52; 95% CI: -7.92, -3.12) (p<0.01 for trend). The greatest neighborhood disadvantage (i.e., T3) was also associated with individual elements of the LE8, including poorer diet quality, higher BMI, and higher systolic and diastolic blood pressure. Conclusions: Neighborhood-level socioeconomic disadvantage was associated with worse CVH in early pregnancy. Multi-level interventions should consider structural approaches that address the social determinants of place-based disparities in maternal CVH.
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