Key result
Higher pregnancy diet quality linked to ~3-point higher midlife cardiovascular health score per SD.
Why the study?
Cardiovascular health often declines in midlife, and while diet during pregnancy may influence long-term cardiovascular health, few studies have examined this relationship.
Does higher diet quality during pregnancy improve midlife cardiovascular health (Life's Essential 8 scores) in women two decades later?
Cohort (n=776)
Does higher diet quality during pregnancy improve midlife cardiovascular health (Life's Essential 8 scores) in women two decades later?
Healthier diet quality during pregnancy is prospectively associated with better behavioural and biomedical cardiovascular health scores in women two decades later during midlife.
Supports hypothesis-generating link of pregnancy diet quality to midlife CVH; prospective trials needed before clinical adoption.
INTRODUCTION: Cardiovascular health (CVH) often declines in midlife. Diet during pregnancy, a similarly sensitive period involving physiological changes, may influence long-term CVH, but few studies have examined this relationship. We examined the associations between diet during pregnancy and CVH in midlife. METHODS: Participants are 776 women enroled in Project Viva during early pregnancy (1999-2002, mean 32.7 years). Participants completed food frequency questionnaires during the first and second trimesters, from which we calculated three diet scores (higher scores = better diet): Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet (MD) and Dietary Inflammatory Index (DII × -1). We averaged scores across trimesters and generated internal z-scores. At the midlife visit (2017-2021, mean 51.1 y), we assessed CVH using the American Heart Association's Life's Essential 8 (range 0-100; higher scores = better CVH), including behavioural (diet, physical activity, sleep, smoking) and biomedical (BMI, blood pressure, lipids, glucose) subscores. We assessed associations using linear regression adjusted for age, race and ethnicity, nativity, education, parity, marital status and income at enrolment. RESULTS: Most participants were non-Hispanic White (70%) and college graduates (76%). Mean midlife CVH score was 76.3 points. Higher (per 1-SD) DASH z-scores were associated with better overall (β 3.3; 95% CI 2.2-4.3), behavioural (3.5; 2.5-4.4) and biomedical (3.1; 1.5-4.7) CVH scores. Higher MD z-scores were associated with better overall CVH (2.4; 1.4-3.4), behavioural (2.6; 1.6-3.5) and biomedical (2.6; 1.0-4.2) scores. Higher DII (× -1) z-scores were associated with better overall CVH (2.6; 1.6-3.7), behavioural (2.7; 1.7-3.7) and biomedical (2.5; 0.9-4.1) scores. A better pregnancy diet was associated with higher CVH scores for diet, physical activity and BMI, and both DASH and DII with blood pressure. CONCLUSIONS: Women who consumed healthier diets during pregnancy had better CVH two decades later. Dietary assessment in pregnancy may identify women at risk for both short-term and long-term health problems.
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Rifas‐Shiman et al. (2026) conducted a cohort in Cardiovascular health in midlife after pregnancy (n=776). Diet quality during pregnancy (DASH, Mediterranean Diet, and reversed Dietary Inflammatory Index z-scores) vs. Lower pregnancy diet quality (per 1-SD change in internal z-score) was evaluated on Midlife cardiovascular health (CVH) score assessed via American Heart Association's Life's Essential 8 (range 0-100) (β 3.3 (per 1-SD higher DASH z-score), 95% CI 2.2-4.3). Higher pregnancy diet quality (per 1-SD DASH z-score) was associated with better midlife Life's Essential 8 cardiovascular health scores two decades later (β 3.3; 95% CI 2.2-4.3).
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