Social Determinants of Suboptimal Cardiovascular Health Among Pregnant Women in the United States

Garima Sharma, Gowtham R. Grandhi, Isaac Acquah, Reed Mszar, Shiwani Mahajan, Safi U. Khan, Zulqarnain Javed, Laxmi S. Mehta, Martha Gulati, Miguel Cainzos-Achirica, Roger S. Blumenthal, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


BACKGROUND: Suboptimal cardiovascular health (CVH) and social determinants of health (SDOH) have a significant impact on maternal morbidity and mortality. We aimed to evaluate the association of SDOH with suboptimal CVH among pregnant women in the United States. METHODS AND RESULTS: We examined cross-sectional data of pregnant women aged 18 to 49 years from the National Health Interview Survey (2013– 2017). We ascertained optimal and suboptimal CVH based on the presence of 0 to 1 and ≥2 risk factors (hypertension, diabetes, hyperlipidemia, current smoking, obesity, and insufficient physical activity), respectively. We calculated an aggregate SDOH score representing 38 variables from 6 domains (economic stability; neighborhood, physical environment, and social cohesion; community and social context; food; education; and healthcare system) and divided into quartiles. We used Poisson regression model to evaluate the association of SDOH with suboptimal CVH and risk factors. Our study included 1433 pregnant women (28.8±5.5 years, 13% non-Hispanic Black). Overall, 38.4% (95% CI, 33.9– 43.0) had suboptimal CVH versus 51.7% (95% CI, 47.0– 56.3) among those in the fourth SDOH quartile. Risk ratios of suboptimal CVH, smoking, obesity, and insufficient physical activity were 2.05 (95% CI, 1.46– 2.88), 8.37 (95% CI, 3.00– 23.43), 1.54 (95% CI, 1.17– 2.03), and 1.19 (95% CI, 1.01–1.42), respectively among those in the fourth SDOH quartile compared with the first quartile. CONCLUSIONS: Over 50% of pregnant women with the highest SDOH burden had suboptimal CVH, highlighting the public health urgency for interventions in socially disadvantaged pregnant women with renewed strategies toward improving modifiable risk factors, especially smoking and insufficient physical activity.

Original languageEnglish (US)
Article numbere022837
Pages (from-to)e022837
JournalJournal of the American Heart Association
Issue number2
StatePublished - Jan 18 2022


  • Cardiovascular disease
  • Cardiovascular health
  • Cardiovascular risk factors
  • Maternal health
  • Pregnancy
  • Social determinants of health
  • Obesity
  • Cross-Sectional Studies
  • Cardiovascular Diseases/epidemiology
  • Humans
  • Middle Aged
  • Risk Factors
  • Young Adult
  • United States/epidemiology
  • Social Determinants of Health
  • Adolescent
  • Pregnant Women
  • Adult
  • Female

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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