Pregnancy, Socioeconomic Status, and Cardiovascular Risk

July 21st, 2025

Researchers conducted a secondary analysis of the Nulliparous Pregnancy Outcomes Study — Monitoring Mothers-to-be (nuMoM2b) to assess the relationship between neighborhood-level socioeconomic inequity and predicted long-term cardiovascular outcomes. The multicenter prospective study enrolled nulliparous pregnant women across eight U.S. clinical sites between 2010 and 2013.

This sub-analysis included 4,309 women with follow-up data collected 2 to 7 years postpartum (median: 3.1 years). Neighborhood disadvantage was measured using the 2015 Area Deprivation Index (ADI), stratified into tertiles from least (T1) to most deprived (T3).

Key Findings: Higher Deprivation Linked to Higher Predicted CVD Risk

Cardiovascular risk was measured using the Framingham 30-year risk prediction model for both atherosclerotic CVD (ASCVD) and total CVD (which includes heart failure, stroke, and coronary insufficiency).

• Women in the most deprived neighborhoods (T3) had:

  • Higher 30-year ASCVD risk (adjusted β = 0.41; 95% CI, 0.19-0.63)

  • Higher 30-year total CVD risk (adjusted β = 0.74; 95% CI, 0.36-1.13)

  • 2.21 times the adjusted relative risk of having ASCVD risk ≥10%

  • 1.35 times the adjusted relative risk of total CVD risk ≥10%

These associations remained significant even after adjusting for individual SES variables such as income, education, and insurance status, indicating an independent effect of neighborhood-level socioeconomic disadvantage.

Addressing Social Determinants of Cardiovascular Health

An intersectional perspective is crucial. Black and minority women often face systemic racism in addition to socioeconomic challenges, compounding their risk for both poor pregnancy outcomes and chronic disease.

To reduce maternal cardiovascular risk linked to socioeconomic inequity, the following strategies are essential:

• Expand access to prenatal and postpartum care for underserved populations.

• Integrate social risk screening into routine maternal healthcare.

• Invest in community-based health education and support programs.

• Implement policies that address poverty, housing, and education disparities.

Conclusion: Maternal Health Equity Is Key to Preventing Long-Term CVD

This analysis of the nuMoM2b cohort reveals that socioeconomic inequities during pregnancy significantly increase a woman’s long-term risk for cardiovascular disease. These findings support the urgent need for maternal health equity initiatives that address both clinical care and the broader social conditions that shape cardiovascular outcomes.

For a fuller look at the study and its conclusions, click here.