Prospective Associations of Diet Quality During Pregnancy With Cardiovascular Health (Life's Essential 8) Among Women in Midlife

INTRODUCTION: Cardiovascular health (CVH) often declines in midlife. Diet during pregnancy, a similarly sensitive period involving physiological changes, may influence long-term CVH, but few studies have examined this relationship. We examined the associations between diet during pregnancy and CVH in midlife. METHODS: Participants are 776 women enroled in Project Viva during early pregnancy (1999-2002, mean 32.7 years). Participants completed food frequency questionnaires during the first and second trimesters, from which we calculated three diet scores (higher scores = better diet): Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet (MD) and Dietary Inflammatory Index (DII × -1). We averaged scores across trimesters and generated internal z-scores. At the midlife visit (2017-2021, mean 51.1 y), we assessed CVH using the American Heart Association's Life's Essential 8 (range 0-100; higher scores = better CVH), including behavioural (diet, physical activity, sleep, smoking) and biomedical (BMI, blood pressure, lipids, glucose) subscores. We assessed associations using linear regression adjusted for age, race and ethnicity, nativity, education, parity, marital status and income at enrolment. RESULTS: Most participants were non-Hispanic White (70%) and college graduates (76%). Mean midlife CVH score was 76.3 points. Higher (per 1-SD) DASH z-scores were associated with better overall (β 3.3; 95% CI 2.2-4.3), behavioural (3.5; 2.5-4.4) and biomedical (3.1; 1.5-4.7) CVH scores. Higher MD z-scores were associated with better overall CVH (2.4; 1.4-3.4), behavioural (2.6; 1.6-3.5) and biomedical (2.6; 1.0-4.2) scores. Higher DII (× -1) z-scores were associated with better overall CVH (2.6; 1.6-3.7), behavioural (2.7; 1.7-3.7) and biomedical (2.5; 0.9-4.1) scores. A better pregnancy diet was associated with higher CVH scores for diet, physical activity and BMI, and both DASH and DII with blood pressure. CONCLUSIONS: Women who consumed healthier diets during pregnancy had better CVH two decades later. Dietary assessment in pregnancy may identify women at risk for both short-term and long-term health problems.