Association of neighborhood-level socioeconomic disadvantage and Life's Essential 8 in early pregnancy

• The relationship between neighborhood-level social determinants of health and Life's Essential 8 remains to be examined in pregnancy. • In a multisite US cohort of individuals in their first pregnancy, neighborhood-level socioeconomic disadvantage per the Area Deprivation Index was associated with worse maternal cardiovascular health per the Life's Essential 8 in early pregnancy. • Future studies should explore whether assessment of neighborhood-level social determinants of health and cardiovascular health could be integrated into pregnancy care to improve outcomes. We examined whether neighborhood-level socioeconomic disadvantage per the Area Deprivation Index (ADI) was associated with maternal cardiovascular health (CVH) in early pregnancy per the American Heart Association Life's Essential 8 (LE8). This is a cross-sectional analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study (nuMoM2b-HHS) cohort. The exposure was the ADI in tertiles (T) from least (T1) to most (T3) socioeconomic disadvantage. The outcome was the LE8 as a continuous score ranging from worst (0) to best (100) composite CVH; and included physical activity, diet quality, tobacco use, sleep quantity, body mass index, blood pressure, glucose, and lipid levels. Among 4,508 nulliparous individuals at a mean maternal age of 27.0 years (SD: 5.6) and at a mean gestational age of 11.4 weeks (SD 1.6), the mean ADI was 48.0 (SD: 30.4) and the mean LE8 was 80.3 (SD: 12.5). Pregnant individuals living in neighborhoods with greater socioeconomic disadvantage had lower mean LE8 scores (i.e., worse CVH) compared with those living in neighborhoods with lesser disadvantage (T1 vs. T2 adjusted mean: 82.6 vs. 80.5; adj. ß:2.08; 95 % CI:3.51, -0.64; and T1 vs. T3 adjusted mean: 82.6 vs. 77.8; adj. ß:4.77; 95 % CI:8.16, -1.38). Neighborhood-level socioeconomic disadvantage was associated with worse maternal CVH in early pregnancy.