Gestational cardiovascular health and adverse pregnancy outcomes: a prospective cohort study in China

BACKGROUND: Pregnancy is regarded as a crucial window period for the assessment and management of cardiovascular health (CVH). This study investigated the relationship between the gestational CVH metrics of Chinese women and adverse pregnancy outcomes. PATIENTS AND METHODS: Six separate CVH metrics (smoking status, body mass index, blood pressure, total cholesterol, fasting blood glucose, and sleep health) were measured at 24-28 gestational weeks and categorized as ideal (2 points), intermediate (1 point), or poor (0 point) to generate a gestational CVH score. Total gestational CVH was categorized as high (all ideal metrics), moderate (no poor metrics), or low (one or more poor metric). Associations between gestational CVH and adverse pregnancy outcomes were evaluated using Poisson regression. RESULTS: Among the 2,775 pregnant women included, 36.07%, 36.11%, and 27.82% had high, moderate, and low CVH, respectively. Each one-point increase in the CVH score was significantly associated with 7% and 4% lower risk of adverse maternal and neonatal outcomes (relative risk [RR], 0.93 and 0.96; 95% confidence interval [CI], 0.90-0.95 and 0.93-0.98). Compared with low CVH, high CVH was associated with 21% and 12% lower risk of adverse maternal and neonatal outcomes (RR, 0.79 and 0.88; 95% CI, 0.72-0.87 and 0.80-0.96). Individual CVH metrics also showed associations with adverse pregnancy outcomes, in which ideal body mass index, fasting blood glucose and sleep health were particularly important. CONCLUSIONS: High gestational CVH was significantly associated with a considerably lower risk of adverse pregnancy outcomes, but approximately two-thirds of pregnant Chinese women do not achieve a high level of CVH.