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First get your heart in shape. Then get pregnant.

Most women in the U.S. have poor heart health before becoming pregnant
young woman jogs for good heart health

This Valentine’s Day, a new Northwestern Medicine study shines a spotlight on an important but often overlooked matter of the heart — optimizing one’s cardiovascular health before getting pregnant. 

More than one in two young women between the ages of 20 and 44 who gave birth in the United States in 2019 had poor heart health before becoming pregnant, the study found. Poor heart health puts expectant mothers and their babies at risk, with heart disease causing more than one in four pregnancy-related deaths

“As women, we tend to think about the baby’s health once we become pregnant, but what so many women don’t realize is the very first thing they can do to protect their babies (and themselves) is to get their heart in shape before they even conceive,” said senior study author Dr. Sadiya Khan, assistant professor of medicine in cardiology and epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. 

The study was published Feb. 14 in Circulation, the American Heart Association’s (AHA) peer-reviewed flagship journal, as part of a themed issue for the Go Red for Women Campaign that was developed by the AHA in 2004 to highlight awareness about heart disease risks in women.

More than half the women in the study had at least one risk factor for poor heart health, including overweight/obesity, hypertension or diabetes before becoming pregnant. Being overweight or obese was the most common reason for poor heart health before pregnancy, the study found. 

“Women with favorable heart health before pregnancy are less likely to experience complications of pregnancy and are more likely to deliver a healthy baby,” said lead study author Dr. Natalie Cameron, an internal medicine specialist and instructor at Feinberg and a Northwestern Medicine physician. “Even more importantly, optimizing heart health before and during pregnancy can prevent the development of heart disease years later. Clinicians can play a key role in both assessing and optimizing heart health prior to pregnancy.”

Better heart health before pregnancy in the West, Northeast

The scientists compared data by geographical region and even as good heart health was declining overall across the country, there were geographic differences. The percentage of women with good heart health was lower in South (38.1%) and Midwest (38.8%) states, compared with states in the West (42.2%) and Northeast (43.6%). There were also variations among states, ranging from less than one-third of women in Mississippi (31.2%) having good heart health prior to pregnancy compared to nearly half (47.2%) in the best U.S. state: Utah.  

“The geographic patterns observed here are, unfortunately, very similar to what we see for heart disease and stroke in both women and men,” Khan said. “They indicate factors, such as social determinants of health, play a critical role in heart health as well as maternal health. 

“Pregnancy is often described as a window to future heart health, and taking the opportunity to leverage the prenatal period to optimize maternal heart health is critical. But we also need to focus on optimizing cardiovascular health throughout young adulthood because nearly half of pregnancies are unplanned. We need to emphasize heart health across the life span.”

The scientists encourage women to see a doctor or other health care clinician prior to becoming pregnant to take active steps to maintain a healthy lifestyle before and during pregnancy. This involves staying physically active, eating a healthy diet filled with vegetables, whole grains and plant-based proteins, and avoiding tobacco to reduce the risks for being overweight or having high blood pressure or diabetes.

Research notes

The scientists analyzed data from the U.S. Centers for Disease Control and Prevention’s Natality Database 2016-2019. They identified the pre-pregnancy heart health risk factors of 14,174,625 women with live births. The women ranged in age from 20 to 44 years old: 81.4% were between the ages of 20 to 34; 52.7% were non-Hispanic white; 22.7% were Hispanic/Latina; and 14% were non-Hispanic Black. Optimal heart health was defined as having a normal body weight with a Body Mass Index between 18-24.9kg/m2 and not having hypertension or diabetes.

Other Northwestern authors include: Dr. Priya Freaney, Michael Wang, Dr. Amanda Perak, Dr. Brigid Dolan, Dr. Matthew O’Brien, S. Darius Tandon, Dr. Matthew Davis, Norrina Allen, Dr. Philip Greenland and Dr. Donald Lloyd-Jones.

This work was supported by grants from the National Heart, Lung, and Blood Institute (grant numbers 1R01HL159250 and 1U01HL160279-01), of the National Institutes of Health, and the American Heart Association Transformational Project Award (grant number 19TPA34890060). 

For Journalists: view the news release for media contacts