Cardiovascular Health Among Pregnant Women, Aged 20 to 44 Years, in the United States

Background: Pregnancy is a cardiometabolic stressor and thus a critical period to address women's lifetime cardiovascular health (CVH). However, CVH among US pregnant women has not been characterized. Methods and Results: We analyzed cross-sectional data from National Health and Nutrition Examination Surveys 1999 to 2014 for 1117 pregnant and 8200 nonpregnant women, aged 20 to 44 years. We assessed 7 CVH metrics using American Heart Association definitions modified for pregnancy; categorized metrics as ideal, intermediate, or poor; assigned these categories 2, 1, or 0 points, respectively; and summed across the 7 metrics for a total score of 0 to 14 points. Total scores 12 to 14 indicated high CVH; 8 to 11, moderate CVH; and 0 to 7, low CVH. We applied survey weights to generate US population-level estimates of CVH levels and compared pregnant and nonpregnant women using demographic-adjusted polytomous logistic and linear regression. Among pregnant women, the prevalences (95% CIs) of ideal levels of CVH metrics were 0.1% (0%–0.3%) for diet, 27.3% (22.2%–32.3%) for physical activity, 38.9% (33.7%–44.0%) for total cholesterol, 51.1% (46.0%–56.2%) for body mass index, 77.7% (73.3%–82.2%) for smoking, 90.4% (87.5%–93.3%) for blood pressure, and 91.6% (88.3%–94.9%) for fasting glucose. The mean total CVH score was 8.3 (95% CI, 8.0–8.7) of 14, with high CVH in 4.6% (95% CI, 0.5%–8.8%), moderate CVH in 60.6% (95% CI, 52.3%–68.9%), and low CVH in 34.8% (95% CI, 26.4%–43.2%). CVH levels were significantly lower among pregnant versus nonpregnant women; for example, 13.0% (95% CI, 11.0%–15.0%) of nonpregnant women had high CVH (adjusted, comparison P=0.01). Conclusions: From 1999 to 2014, <1 in 10 US pregnant women, aged 20 to 44 years, had high CVH.