AHA: Target prepregnancy for optimal CV health across generations
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Optimizing a person’s CV health before they become pregnant, beginning as early as adolescence, can reduce risk for adverse outcomes during pregnancy and improve CV health for their offspring, researchers reported.
In a new scientific statement from the American Heart Association, researchers noted that the time before pregnancy is a “critical life period” for impacting CV health and called for more public health and research efforts to optimize healthy outcomes.
“The rising crisis for maternal morbidity and mortality is a major public health problem, particularly related to CVD,” Sadiya S. Khan, MD, MSc, FACC, FAHA, assistant professor of medicine and preventive medicine, associate program director of the cardiovascular disease fellowship and director of research in the section of heart failure at Northwestern University Feinberg School of Medicine, and chair of the scientific statement writing group, told Healio. “What we wanted to highlight with this statement is think about opportunities for intervention when there may be maximal benefit, particularly on an individual level but also a population level. Many of the issues we are seeing, like new-onset diabetes or preeclampsia, are not necessarily isolated to pregnancy but are being set up in the context of the health of the pregnant person coming into pregnancy.”
Reaching people early
Low levels of prepregnancy CV health are associated with several pregnancy complications including gestational diabetes, preeclampsia and preterm birth, according to the researchers. The statement notes that all clinicians who interact with people with a capacity for pregnancy can emphasize optimization of CV health, beginning early in childhood, using metrics like the AHA’s Life’s Essential 8, an updated checklist that now includes assessment of sleep health metrics. The researchers added that clinical trials are still needed to investigate prepregnancy interventions to comprehensively target CV health.
Additionally, community-level interventions and policy-level changes are needed to better reach people from underrepresented backgrounds who could become pregnant but continue to have unequal access to health care, Khan said.
“We know that many pregnancies are unintended,” Khan said in an interview. “That sets up a dynamic where it is difficult to intervene before pregnancy. That has to be addressed more globally. We must prioritize CV health in childhood and adolescence, as individuals are entering their reproductive years. We have to partner with our pediatric and adolescent medicine colleagues. We have to think about these conversations before someone is even considering pregnancy.”
Address access to care
Many reproductive-aged people have inadequate, fragmented health care before and after pregnancy and between pregnancies, Khan said. Access to care continues to be a barrier for many people before they become pregnant, often due to social determinants of health.
“There are many reasons why people do not come in for preconception care and a lot of them are structural or access reasons,” Khan said. “It is so important to know your numbers, and that is where the Life’s Essential 8 framework comes in.”
The researchers noted the prepregnancy period offers a unique window of opportunity to address the growing public health burden of adverse pregnancy outcomes and “interrupt the intergenerational transmission of poor CV health.”
“Leveraging these opportunities to target CV health has the potential to improve health across the life course and for subsequent generations,” Khan told Healio. “One of the reasons we think this is such a priority is how critical this is to generational health, given the implications of how the pregnancy can affect the child’s health also.”
For more information:
Sadiya S. Khan, MD, MSc, FACC, FAHA, can be reached at s-khan-1@northwestern.edu; Twitter: @heartdocsadiya.
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