September 15, 2026Open Access
Impact of Social Determinants of Health in Early Pregnancy on Racial and Ethnic Differences in Post-pregnancy Cardiovascular Health
Key result
Adverse SDOH explain ~37% of the Black-White post-pregnancy cardiovascular health gap.
- MD −4.5
- 95% CI 2.8-6.2
- P<0.01
- n=4,088
Why the study?
The extent to which social determinants of health in early pregnancy explain racial and ethnic differences in post-pregnancy cardiovascular health has not been defined.
To what extent do social determinants of health in early pregnancy explain racial and ethnic differences in post-pregnancy cardiovascular health?
Study Design
Type
Cohort (n=4,088)
Multicenter
Yes
Structured PICO
To what extent do social determinants of health in early pregnancy explain racial and ethnic differences in post-pregnancy cardiovascular health?
P
Population
4,088 women (14.4% Black, 17.6% Hispanic, 68.0% White) with cardiovascular health assessed in early pregnancy and 2-7 years after delivery.
E
Exposure
Social determinants of health (SDOH) in early pregnancy
C
Comparator
Non-Hispanic White women
O
Outcome
Post-pregnancy cardiovascular health (CVH) assessed using the American Heart Association's Life's Essential 8 (LE8) framework 2-7 years after deliverysurrogate
Main Result
Mean Difference: 4.5 (95% CI 2.8–6.2)
Absolute Event Rate: 70.1% vs 82.4%
p-value: p=<0.01
Social determinants of health in early pregnancy explain a substantial portion of the racial and ethnic disparities in cardiovascular health 2 to 7 years postpartum, highlighting the need for sustained cardiovascular follow-up after delivery.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Despite an increasing awareness of racial and ethnic differences in postpartum cardiovascular outcomes, few studies have addressed the role of socioeconomic status in large, prospective and well-designed cohorts like this one. Identifying the role of socioeconomic status in postpartum cardiovascular health provides supporting data to augment affordable preventive postpartum care, such as extending Medicaid postpartum coverage to one year.”
“Socioeconomic status is very important, however, I am surprised that it appears to explain the majority of the differences in cardiovascular health two to seven years after giving birth. For some people, their socioeconomic status probably doesn't change that much during this period. So, if in an ideal society we could have similar socioeconomic status across racial-ethnic groups, then most of the disparities in cardiovascular health may be eliminated.”
Implication
May warrant SDOH screening in early pregnancy to flag CVH risk; hypothesis-generating for equity interventions and requires prospective confirmation.
Abstract
Background: Social determinants of health (SDOH) influence maternal cardiovascular health (CVH), but the extent to which SDOH in early pregnancy may explain racial and ethnic differences in post-pregnancy CVH has not been defined. Methods: This secondary analysis used data from the prospective multisite Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study. CVH was assessed in early pregnancy and 2-7 years after delivery using the American Heart Association's Life's Essential 8 (LE8) framework. We used the Oaxaca-Blinder decomposition to quantify the statistical contributions of differences in early pregnancy CVH, SDOH, psychosocial factors, and demographic covariates to racial and ethnic differences in post-pregnancy CVH between the two largest minoritized racial and ethnic groups (non-Hispanic [NH] Black and Hispanic) compared with NH White women. Results: Among 4,088 women (14.4% Black, 17.6% Hispanic, and 68.0% White), the mean (SD) post-pregnancy LE8 score was lower in Black (70.1 [14.1]) and Hispanic (77.8 [12.7]) women compared with White women (82.4 [12.7]) (all p<0.01). Independent of early pregnancy CVH, maternal age, and nativity, differences in SDOH were associated with 4.5 (95% CI, 2.8-6.2) points of the Black-White gap (37% of the observed post-pregnancy CVH difference) and 3.2 (95% CI, 1.1-5.3) points of the Hispanic-White gap (70% of the observed post-pregnancy CVH difference), respectively. Conclusions: Most racial and ethnic differences in post-pregnancy CVH 2 to 7 years after a first birth were explained by differences in early pregnancy CVH and SDOH. Independent of early pregnancy CVH, SDOH remained the largest measured contributor to the residual difference. CLINICAL PERSPECTIVE: Because differences in cardiovascular health persisted beyond what differences in measured social risk factors explained, social risk screening in early pregnancy should be paired with sustained cardiovascular follow-up after delivery rather than treated as sufficient on its own. Black women did not experience the improvements in physical activity and smoking cessation seen in other groups after a first birth, identifying the postpartum period as a window for behavioral cardiovascular risk reduction.
Discussion
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Cite This Study
Huang et al. (2026) conducted a cohort in Post-pregnancy cardiovascular health (n=4,088). Social determinants of health (SDOH) vs. Non-Hispanic White women was evaluated on Post-pregnancy cardiovascular health (Life's Essential 8 score) (MD 4.5, 95% CI 2.8-6.2, p=<0.01). Differences in social determinants of health accounted for 4.5 points (37%) of the Black-White gap and 3.2 points (70%) of the Hispanic-White gap in post-pregnancy cardiovascular health.