Introduction: Cardiovascular disease remains a leading cause of morbidity among women, with pregnancy offering a critical window to identify future risk. Structural factors, such as neighborhood disadvantage, may have lasting effects on cardiovascular health beyond individual behaviors or experiences. This analysis evaluated if neighborhood-level deprivation and individual-level social vulnerability (SV; i.e., social determinants of health and exposures of daily living such as discrimination and perceived stress) in pregnancy were related to blood pressure (BP) 2- to 7-years after delivery. Hypothesis: Neighborhood disadvantage and SV would each be prospectively associated with elevated BP in women. Methods: This was a secondary analysis of the nuMoM2b-HHS study. The study followed a diverse cohort of healthy nulliparous women in 8 U.S. medical centers from the first trimester through 2-7 years after delivery of their first child to characterize adverse pregnancy outcomes and subsequent cardiovascular risk. In this analysis, Area Deprivation Index (ADI; a measure of structural disadvantage) and SV (a composite of residential history, health literacy, financial stress, discrimination, perceived stress, social connectivity, and perceived pregnancy experiences) were examined in relation to systolic and diastolic BP (SBP and DBP) at the 2- to 7-year postpartum study visit. Covariates were age, race/ethnicity, first trimester BP, and pre-pregnancy body mass index and smoking. General linear models first included each predictor separately, and final models included both ADI and SV to investigate their distinct associations. Results: The sample (n=3728) had a mean age 31±5.6 and 65% were White race; mean follow-up was 3.2±0.9 years after delivery. ADI and SV were each associated with greater SBP and DBP at follow-up in unadjusted models (Table), but after covariate adjustment, only ADI was associated with SBP and DBP. In models including mutual adjustment for ADI and SV, only ADI was associated with SBP and DBP. Conclusions: Area-level social deprivation – but not individual SV during pregnancy – was associated with elevated BP about 3 years later. Where a woman lives during pregnancy may have a greater impact on her later cardiovascular health than her social experiences or vulnerabilities during pregnancy. These findings show a need to understand structural and neighborhood-level health determinants during pregnancy for long-term maternal cardiovascular health.
Gaffey et al. (Mon,) studied this question.