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.