JACC. Advances · 2025
Psychological Distress and Cardiovascular Health in Pregnancy: Findings From the U.S. National Health Interview Survey.
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Satti Danish Iltaf, Chan Jeffrey Shi Kai, Metlock Faith E, Mszar Reed, Mehta Adhya, Chan Raymond Ngai Chiu, Chang Ryan, Spitz Jared, Saad Antonio, Gaffey Allison E, Javed Zulqarnain, Dastmalchi Lily Nedda, Mehta Anurag, Powell-Wiley Tiffany, Sharma Garima
Аннотация
BACKGROUND: The relationship between psychological health and cardiovascular health (CVH) during pregnancy is not well characterized.
OBJECTIVES: The purpose of this study was to perform a cross-sectional analysis in order to assess the relationships between psychological distress and CVH among pregnant individuals in the United States.
METHODS: U.S. National Health Interview Survey (2013-2018) data were used for the analyses. The sample included all pregnant participants aged ≥18 years, but excluded those with missing data for the exposure, outcome, or covariates. Psychological health was measured with the 6-item Kessler scale, and severe psychological distress was defined as 6-item Kessler scale ≥13. CVH was quantified using the American Heart Association's Life's Essential 8; as detailed dietary data were unavailable, a 7-item score was used (higher scores indicated worse CVH). Multivariable Poisson regression tested associations between severe psychological distress and CVH, adjusting for potential confounders including age, race/ethnicity, sexual orientation, education level, family income, any known cardiovascular conditions, and insurance.
RESULTS: Among 1,110 pregnant individuals (representing >1.5 million pregnant individuals each year of the survey), 3.5% reported severe psychological distress (95% CI: 2.2%-5.5%), 21.7% reported moderate psychological distress (95% CI: 18.8%-24.9%), and 74.9% reported either mild or no psychological distress (95% CI: 71.4%-78.0%). Individuals reporting moderate psychological distress (adjusted rate ratio: 1.25 [95% CI: 1.13-1.38], P < 0.001) or severe psychological distress (adjusted rate ratio: 1.42 [95% CI: 1.20-1.68], P < 0.001) had lower CVH scores compared to those with mild or no psychological distress. A stepwise relation was observed between the severity of psychological distress and CVH.
CONCLUSIONS: We observed a strong association between psychological distress and suboptimal CVH during pregnancy, highlighting the need to manage psychological health along with CVH in pregnant individuals.
OBJECTIVES: The purpose of this study was to perform a cross-sectional analysis in order to assess the relationships between psychological distress and CVH among pregnant individuals in the United States.
METHODS: U.S. National Health Interview Survey (2013-2018) data were used for the analyses. The sample included all pregnant participants aged ≥18 years, but excluded those with missing data for the exposure, outcome, or covariates. Psychological health was measured with the 6-item Kessler scale, and severe psychological distress was defined as 6-item Kessler scale ≥13. CVH was quantified using the American Heart Association's Life's Essential 8; as detailed dietary data were unavailable, a 7-item score was used (higher scores indicated worse CVH). Multivariable Poisson regression tested associations between severe psychological distress and CVH, adjusting for potential confounders including age, race/ethnicity, sexual orientation, education level, family income, any known cardiovascular conditions, and insurance.
RESULTS: Among 1,110 pregnant individuals (representing >1.5 million pregnant individuals each year of the survey), 3.5% reported severe psychological distress (95% CI: 2.2%-5.5%), 21.7% reported moderate psychological distress (95% CI: 18.8%-24.9%), and 74.9% reported either mild or no psychological distress (95% CI: 71.4%-78.0%). Individuals reporting moderate psychological distress (adjusted rate ratio: 1.25 [95% CI: 1.13-1.38], P < 0.001) or severe psychological distress (adjusted rate ratio: 1.42 [95% CI: 1.20-1.68], P < 0.001) had lower CVH scores compared to those with mild or no psychological distress. A stepwise relation was observed between the severity of psychological distress and CVH.
CONCLUSIONS: We observed a strong association between psychological distress and suboptimal CVH during pregnancy, highlighting the need to manage psychological health along with CVH in pregnant individuals.