Cardiovascular Health Profiles in Pregnant, Postpartum, and Nonpregnant Reproductive-Aged Women Using Life’s Essential 8 Scores

BACKGROUND: Adverse pregnancy outcomes are a major driver of high maternal mortality in the United States. There are limited data on cardiovascular health (CVH) in reproductive-aged women nationally. OBJECTIVES: The objective of the study was to assess CVH in pregnant, postpartum, and nonpregnant women of reproductive age using the American Heart Association Life's Essential 8 (LE8) score. METHODS: We performed serial cross-sectional analysis of reproductive-aged women 20 to 44 years of age in the United States participating in the National Health and Nutrition Examination Survey from 2015 to 2023. Overall CVH scores (0-100) were calculated using the LE8 core components in nonpregnant women and women with any pregnancy-related condition (defined as currently pregnant, pregnant within 1 year of the survey, and/or breastfeeding). Population weighted analyses were used to compare CVH scores between groups. RESULTS: Among 3,992 participants (representing 46.9 million U.S. women), 10.7% were pregnant, breastfeeding, or postpartum. Overall, the mean LE8 score was 66 corresponding to moderate CVH, with similar scores among women with any pregnancy-related condition compared to nonpregnant women (65 vs 66, P = 0.20). Pregnant women (62) had the lowest LE8 scores compared to postpartum (67), breastfeeding (70), and nonpregnant women (66), respectively, P < 0.001. In addition, high-sensitive C-reactive protein levels were significantly elevated in pregnant women (4.68 mg/dL) compared to postpartum (2.39 mg/dL), breastfeeding (2.40 mg/dL), and nonpregnant women (2.06 mg/dL) (P = 0.006). CONCLUSIONS: Reproductive-aged women in the United States demonstrated moderate CVH, with pregnant women exhibiting lower LE8 scores compared to postpartum and nonpregnant women. These findings highlight modifiable targets for interventions to reduce adverse pregnancy outcomes and future cardiovascular risk.