Association between maternal cardiovascular health assessed by modified Life's Essential 8 and risks of adverse pregnancy outcomes.

BACKGROUND

The American Heart Association (AHA) has updated the definition of cardiovascular health (CVH) from "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). The association between gestational LE8 CVH status and adverse pregnancy outcomes is unclear.

METHODS

We recruited pregnant women from the China birth cohort study during 6-13+6 gestation weeks and followed them up until delivery to identify pregnancy outcomes. According to the modified AHA definitions, baseline gestational modified LE8 (mLE8) and LS7 CVH scores were calculated based on body mass index, nicotine exposure, physical activity, diet, blood pressure, blood glucose, and lipid levels. Multivariable adjusted logistic regression and receiver operating characteristic (ROC) curves were used to investigate the association between gestational CVH and adverse pregnancy outcomes.

RESULTS

Among the 5168 pregnant women finally included, the overall gestational mLE8 CVH score was 81.4 ± 9.6 points. After multivariate adjustment, each 10-points increase in the total overall gestational mLE8 CVH score was significantly associated with a decreased risk of pregnancy loss [odds ratio (OR) = 0.85, 95% CI: 0.76-0.95), hypertensive disorders of pregnancy (OR = 0.50, 95% CI: 0.44-0.58), gestational diabetes mellitus (GDM) (OR = 0.62, 95% CI: 0.57-0.67), preterm birth (OR = 0.76, 95% CI: 0.67-0.86), large-for-gestational age (LGA) (OR = 0.81, 95% CI: 0.73-0.90), and cesarean delivery (OR = 0.77, 95% CI: 0.72-0.82)]. The areas under the ROC curves (AUC) of mLE8 were higher than those of LS7 for pregnancy loss (0.553 vs. 0.537, p = 0.031), GDM (0.626 vs. 0.615, p = 0.023), LGA (0.575 vs. 0.557, p = 0.016), and cesarean delivery (0.574 vs. 0.564, p = 0.005).

CONCLUSIONS

Higher gestational mLE8 CVH scores in the first trimester are significantly associated with a lower risk of adverse pregnancy outcomes. Although the capacity to predict adverse pregnancy outcomes was modest, mLE8 slightly outperformed LS7 in predicting PE, GDM, LGA, and cesarean delivery.