Differences in education contribute to disparities in early pregnancy heart health
Key takeaways:
- Educational attainment may partly explain disparities in first-trimester heart health.
- White individuals in their first trimester had more years of education on average vs. Black and Hispanic individuals.
Education was demonstrated to be a potentially significant factor explaining racial/ethnic differences in early pregnancy heart health among Black and Hispanic individuals compared with white individuals, researchers reported.
An analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (nuMoM2b) study was published in Circulation: Cardiovascular Quality and Outcomes.
“Entering pregnancy with poor CV health is an important risk factor for adverse maternal outcomes,” Natalie A. Cameron, MD, MPH, instructor in medicine (general internal medicine) and preventive medicine (epidemiology) at Northwestern University Feinberg School of Medicine, told Healio. “There are substantial racial and ethnic disparities in both CV health and maternal morbidity and mortality. Understanding the factors that drive racial and ethnic differences in CV health can help inform public health efforts to improve maternal health.”
To evaluate the contribution of individual- and neighborhood-level factors to racial/ethnic differences in early pregnancy CV health, Cameron and colleagues reviewed data from 9,104 nulliparous individuals with singleton, viable pregnancies recruited during their first trimester to the nuMoM2b study (mean age, 27 years).
First-trimester CV health was quantified on a scale of 0 to 100 using six routinely assessed factors in pregnancy: BP, BMI, diet, nicotine use, physical activity and sleep.
Additionally, differences in early pregnancy CV health and race/ethnicity were also assessed based on various self-reported individual- and neighborhood-level factors.
Overall, 18.7% of participants identified as Hispanic, 15.6% identified as Black and 65.8% identified as white.
The average CV health scores for nulliparous individuals with singleton, viable pregnancies were 76.7 for Hispanic individuals, 69.8 for Black individuals and 79.9 for white individuals (P < .01).
The researchers reported that individual- and/or neighborhood-level factors explained 100% of the differences in CV health between Hispanic and white pregnancies and 82% of differences in CV health between Black and white pregnancies.
Education a major factor in early pregnancy CV health
Of the individual- and/or neighborhood-level factors evaluated in this study, none had an impact on early pregnancy CV health scores greater than educational attainment, according to the study.
“I was not totally surprised by the effect of education on racial and ethnic differences in early pregnancy CV health. Interestingly, researchers at Northwestern have seen similar results regarding education in nonpregnant populations (Shah NS, et al. Circulation. 2022;doi:10.1161/CIRCULATIONAHA.122.061991),” Cameron told Healio. “Regardless, these results are striking. If racial and ethnic groups achieved the same average years of education, the gaps in heart health between the groups could be substantially reduced. The pathways linking education to heart health are likely complex and may be related to income, health insurance, access to health care and health-related knowledge.”
Mean educational attainment was 14 years for Hispanic individuals, 13.4 years for Black individuals and 15.8 years for white individuals. The researchers found that if educational attainment was the same as white individuals for Hispanic individuals, the average first trimester CV health scores would increase by 2.98 points among Hispanic individuals (95% CI, 2.59-3.37).
Similarly, if educational attainment among Black individuals was the same compared with white individuals, they could experience a mean 4.28 CV health point increase (95% CI, 3.77-4.8), the researchers wrote.
‘Reform needs to take place’
“Reform needs to take place at multiple levels of our health care system to address racial and ethnic differences in heart health. These need to take place early in life, even before pregnancy. From a public health standpoint, we need to improve access to healthy foods, build environments where people can safely walk and play, and improve access to preventive health care,” Cameron told Healio. “Researchers and policymakers need to partner with communities to make sure these changes are implemented in ways that support their neighborhoods and well-being. At the clinic level, we need to take a team-based approach. Health care systems and providers need to screen for social determinants of health early in life, before pregnancy. If a specific need is identified, providers can connect patients with social workers and community resources to help address these needs.”
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