New statement summarizes intergenerational impact of heart health before pregnancy

Preventing heart disease starts much earlier than you think, according to a new scientific statement from the American Heart Association published today in a landmark issue of the journal Go Red For Women. Traffic.

The statement, “Optimizing cardiovascular health before pregnancy to improve outcomes in pregnant and postpartum people and their offspring,” summarizes the available data linking a woman’s heart health – including physical, environmental and cognitive experiences. from childhood and young adulthood – to the health of the children born to him. It also highlights the need for continued research and public health intervention to support improved heart health for women across the lifespan.

“Biological processes that contribute to adverse pregnancy outcomes begin before a person becomes pregnant,” said Sadiya S. Khan, MD, M.Sc., FAHA, Chair of the Scientific Statements Writing Group and Assistant Professor of Medicine (Cardiology) and Preventive Medicine (Epidemiology) at the Feinberg School of Medicine at Northwestern University in Chicago. “Therefore, there is a need to focus on optimizing cardiovascular health prior to pregnancy. Evidence indicates that cardiovascular health has an intergenerational relationship. The pre-pregnancy period is a critical life stage that affects health of the person who becomes pregnant and the children born for them.”

The state of health before pregnancy

The key factors for measuring cardiovascular health are based on the American Heart Association’s Life’s Essential 8, which includes a heart-healthy diet, regular physical activity, not smoking; healthy weight, blood pressure, blood cholesterol and blood sugar; and healthy sleep. Using Life’s Essential 8 to assess cardiovascular health in the United States, researchers found that only 1 in 5 people in the United States aged 2 and older had optimal cardiovascular health.

Low levels of cardiovascular health before pregnancy are associated with several pregnancy complications, such as preterm birth, gestational diabetes, high blood pressure, preeclampsia, or delivering a small-for-gestational-age child. . These pregnancy complications are also linked to a higher risk of cardiovascular disease in offspring, according to the latest research:

• Premature birth is associated with a 53% higher risk of heart disease at age 43.
• Having type 2 diabetes before getting pregnant is associated with a 39% higher risk of cardiovascular disease in children at age 40.

Critical gap in research

Despite evidence linking an individual’s pre-pregnancy health to the health of their offspring, there are no large trials with enough people and data to test whether improved health cardiovascular risk before pregnancy will reduce pregnancy complications, pregnancy-related cardiovascular deaths, or cardiovascular risk to offspring.

“If a research trial focusing on pre-pregnancy cardiovascular health was successful in reducing pregnancy complications and improving cardiovascular health for both mother and child, it could change practice,” Khan said.

Future direction of research

New studies aimed at filling research gaps in maternal cardiovascular health must be carefully planned to include people from diverse racial and ethnic backgrounds who are underrepresented in clinical trials. The incidence of pregnancy complications and cardiovascular disease is disproportionately higher among people of various racial and ethnic groups, and this needs to be better understood.

The statement also suggests that research into the prevention or treatment of cardiovascular disease should study lifestyle changes such as heart-healthy diets and physical activity in pregnant women, as well as strategies with drugs known to be safe during pregnancy.

Psychological health, stress and resilience must also be taken into account to optimize cardiovascular health. Importantly, interventions are needed for women from groups historically excluded from public health and research who are susceptible to the psychosocial stress of racial discrimination. Research shows that long-term stressors like ongoing episodes of discrimination are associated with poor cardiovascular health and a higher risk of pregnancy complications. Culturally appropriate stress reduction and mindfulness-based interventions can offer a way to alleviate the stress of these lived experiences.

Community and politics

Community-based interventions are key to improving health equity among all individuals before pregnancy, especially for people from historically marginalized races and ethnicities who often face multiple barriers to optimal health. Furthermore, the influence of structural and social determinants of health require interventions that change society more broadly, such as policies affecting health systems, education, income, housing and food supply. .

“There is a substantial opportunity to improve health across the lifespan and across generations by improving cardiovascular health before pregnancy. However, the responsibility must be borne by all of us, not placed solely on individual women” , Khan said. “The pre-pregnancy period offers a unique window of opportunity to equitably address the increased incidence of adverse pregnancy outcomes, and to interrupt and improve the intergenerational relationship of poor cardiovascular health by focusing on solutions individual, community and political.