Synergistic effects of cardiovascular health and social isolation on adverse pregnancy outcomes

Q: What are the key findings of this study?

Low cardiovascular health during pregnancy was associated with a 2.14-fold increased risk of adverse pregnancy outcomes compared to high cardiovascular health.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Adverse pregnancy outcomes (n=14930). Intervention: Low cardiovascular health (Life's Essential 8) vs. High cardiovascular health. Primary outcome: Composite of preeclampsia, gestational diabetes mellitus, preterm birth, and small for gestational age (RR 2.14, 95% CI 1.78-2.58, p=<0.001).

Q: What question did this study set out to answer?

To evaluate the association between maternal cardiovascular health status during pregnancy and adverse pregnancy outcomes, and to examine how social isolation modifies this risk.

Hisashi Ohseto; Mami Ishikuro; Geng Chen; Ippei Takahashi; Genki Shinoda; Aoi Noda; Keiko Murakami; Masatsugu Orui; Noriyuki Iwama; Masahiro Kikuya; Hirohito Metoki; Atsushi Hozawa; Taku Obara; Shinichi Kuriyama

doi:10.1038/s41598-025-03652-x

May 29, 2025Scientific ReportsOpen Access

Synergistic effects of cardiovascular health and social isolation on adverse pregnancy outcomes

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Key result

Low cardiovascular health during pregnancy is linked to ~114% higher risk of adverse pregnancy outcomes.

RR 2.14
95% CI 1.78-2.58
P<0.001
n=14,930

Figures

Why the study?

Adverse pregnancy outcomes affect approximately 20% of pregnant women with an increasing incidence, prompting investigation into the effect of cardiovascular health during pregnancy on these outcomes.

Do cardiovascular health status and social isolation affect the risk of adverse pregnancy outcomes in pregnant women?

Key Points

To evaluate the association between maternal cardiovascular health status during pregnancy and adverse pregnancy outcomes, and to examine how social isolation modifies this risk.
Analyzed data from 14,930 pregnant women enrolled in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan.
Assessed cardiovascular health (CVH) using Life's Essential 8 metrics (categorized as high, moderate, or low) and tracked composite adverse pregnancy outcomes (APOs), including preeclampsia, gestational diabetes, preterm birth, and small for gestational age.
Performed Poisson regression analyses with robust error variance adjusting for maternal age, alcohol use, in vitro fertilization, parity, psychological distress, social isolation, and household income.
Moderate and low CVH statuses were associated with significantly increased risks of APOs compared with high CVH (moderate: RR 1.15, 95% CI 1.03–1.28; low: RR 2.14, 95% CI 1.78–2.58).
Among women with low CVH, the prevalence of APOs was 36.4% in those with social isolation compared to 27.4% in those without social isolation.
In women with high CVH, the difference in APO prevalence between socially isolated and non-isolated individuals was attenuated (13.6% vs. 13.1%).

Study Design

Type

Cohort (n=14,930)

Multicenter

Yes

Structured PICO

Do cardiovascular health status and social isolation affect the risk of adverse pregnancy outcomes in pregnant women?

P

Population

14,930 pregnant women in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

I

Intervention

Low and moderate cardiovascular health (CVH) status during pregnancy (assessed using Life's Essential 8) and social isolation

C

Comparator

High cardiovascular health (CVH) status and absence of social isolation

O

Outcome

Composite of adverse pregnancy outcomes (APOs) encompassing preeclampsia, gestational diabetes mellitus, preterm birth, and small for gestational agecomposite

Main Result

Effect estimate: RR 2.14 (95% CI 1.78-2.58)

Absolute Event Rate: 29.9% vs 13.1%

p-value: p=<0.001

Lower cardiovascular health during pregnancy, particularly when combined with social isolation, is significantly associated with an increased risk of adverse pregnancy outcomes.

Limitations

Timing of CVH measurements varied among participants
Possibility of reverse causation due to pregnancy course influencing behavior
Validity of the LE8 in the Japanese population has not yet been established

Implication

May inform preconception cardiovascular counseling; leaves open causality, generalizability, and interaction with social isolation.

Abstract

Adverse pregnancy outcomes (APOs) affect approximately 20% pregnant women, and their incidence is increasing. The aim of this study was to investigate the effect of cardiovascular health (CVH) during pregnancy on APOs. We analyzed data from 14,930 pregnant women in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. CVH status during pregnancy was assessed using the eight components of Life's Essential 8. APOs were defined as composite outcomes encompassing preeclampsia, gestational diabetes mellitus, preterm birth, and small for gestational age. The numbers of participants with high, moderate, and low CVH status were 2891 (19.4%), 11,498 (77.0%), and 541 (3.6%), respectively. Poisson regression analyses with robust error variance, which adjusted for maternal age at conception, alcohol consumption, conception via in vitro fertilization, parity, psychological distress, social isolation, and household income, showed a positive association between moderate and low CVH levels and APOs (risk ratio and 95% confidence interval 1.15 [1.03-1.28] and 2.14 [1.78-2.58], respectively). Among pregnant women with low CVH, those who reported social isolation had a higher prevalence of APOs than did those without social isolation (36.4% vs. 27.4%). This difference was attenuated for pregnant women with high CVH status (13.6% vs. 13.1%). In conclusion, CVH status may be useful for assessing the risk of APOs. Socially isolated pregnant women are more vulnerable to the effects of low CVH status.

Discussion

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Cite This Study

Ohseto et al. (2025) conducted a cohort in Adverse pregnancy outcomes (n=14,930). Low cardiovascular health (Life's Essential 8) vs. High cardiovascular health was evaluated on Composite of preeclampsia, gestational diabetes mellitus, preterm birth, and small for gestational age (RR 2.14, 95% CI 1.78-2.58, p=<0.001). Low cardiovascular health during pregnancy was associated with a 2.14-fold increased risk of adverse pregnancy outcomes compared to high cardiovascular health.

synapsesocial.com/papers/6a0ec6758da6dd046147b114 https://doi.org/10.1038/s41598-025-03652-x

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Synergistic effects of cardiovascular health and social isolation on adverse pregnancy outcomes

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Synergistic effects of cardiovascular health and social isolation on adverse pregnancy outcomes

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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