More favorable cardiovascular health during pregnancy, measured with a modified Life’s Essential 8 score, was associated with longer time to clinically recognized cardiometabolic conditions following delivery in a longitudinal cohort study published in JAMA Network Open.
Among 1,225 singleton pregnancies, each 10-point higher modified Life’s Essential 8 (mLE8) score was associated with a 26% longer time to diagnosis of chronic hypertensive conditions and a 20% longer time to diagnosis of chronic metabolic conditions during a median follow-up of 6.2 years.
The study included patients aged 18 to 44 years who received care in a large academic medical system in South Carolina and had no preexisting diabetes or cardiovascular disease (CVD). The cohort had a mean age of 25 years and was racially, ethnically, and socioeconomically diverse: 22% of patients identified as Hispanic, 37% as non-Hispanic Black, and 39% as White; 40% reported an annual income of less than $20,000.
Researchers assessed cardiovascular health during pregnancy using a 7-component modified version of the American Heart Association’s Life’s Essential 8 framework. Scores ranged from 0 to 100, with higher scores indicating more favorable cardiovascular health. The mean score in the cohort was about 70, in the moderate range.
The mLE8 score incorporated hypertensive disorders of pregnancy, glucose screening results, early pregnancy body mass index (BMI), smoking status, sleep adequacy, diet quality, and physical activity. The cholesterol component was excluded because non-high-density lipoprotein cholesterol was unavailable in most patients.
Follow-up began 7 days following delivery and continued through electronic medical record (EMR) surveillance until March 2026. Outcomes were grouped as chronic hypertensive conditions, chronic metabolic conditions, and CVD. The chronic hypertensive analysis included 1,096 patients after excluding those with chronic hypertension at enrollment or during the index pregnancy.
During follow-up, researchers identified 499 incident cardiometabolic events, including 257 chronic metabolic conditions, 209 chronic hypertensive conditions, and 33 CVD events. Kaplan-Meier curves showed longer event-free time for chronic hypertensive and metabolic conditions among patients with higher mLE8 scores. Curves for CVD showed limited separation, consistent with the small number of CVD events.
Researchers used accelerated failure time models, which estimate differences in the timing of diagnosis rather than instantaneous risk. As a result, the findings should be interpreted as associations with time to clinical diagnosis, not proof that better cardiovascular health during pregnancy prevented or delayed biological disease onset.
In component-level analyses, healthier glucose, BMI, hypertension, and sleep scores were associated with longer time to diagnosis of chronic metabolic conditions. For chronic hypertensive conditions, BMI and the hypertension component were statistically significant in the fully adjusted model; glucose, sleep, and physical activity did not reach statistical significance.
Sensitivity analyses were generally consistent after excluding patients with gestational diabetes or hypertensive disorders of pregnancy, suggesting the modified score may identify cardiometabolic vulnerability beyond overt pregnancy complications. Results were also similar after including non-high-density lipoprotein cholesterol in the subset of patients with available lipid data and after additional adjustment for gestational age at enrollment.
The researchers noted several limitations. The observational design cannot establish causality. Diagnosis dates in EMRs likely reflected clinical recognition rather than biological onset, and differences in health care utilization may have influenced time to diagnosis. The mLE8 score requires additional validation because it excluded cholesterol for most patients and incorporated pregnancy-specific measures. Lifestyle components including diet, physical activity, smoking, and sleep relied on self-reported measures, and the small number of CVD events limited interpretation of long-term cardiovascular outcomes. The findings also may not be generalizable to populations with different demographic, socioeconomic, or clinical characteristics.
The findings may have clinical relevance for postpartum and interconception care, the researchers noted. Pregnancy-based cardiovascular health assessment could support earlier transition to primary care, enhanced monitoring of blood pressure, weight, and glucose, targeted lifestyle counseling, and referral for comanagement or specialty follow-up when appropriate.
Disclosures can be found in the published study.
Source: JAMA Network Open
