Impact of Social Determinants of Health in Early Pregnancy on Racial and Ethnic Differences in Post-pregnancy Cardiovascular Health.

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: What Is New?: Among 4,088 women followed 2 to 7 years after a first birth, differences in early pregnancy social determinants of health and cardiovascular health together accounted for approximately three-quarters of the racial and ethnic differences in post-pregnancy cardiovascular health.What Are the Clinical Implications?: 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.