Garima Arora, M.D., Krishin Yerabolu, UAB medical studentResearchers from the University of Alabama at Birmingham Marnix E. Heersink School of Medicine have published a study in Nature showing that pregnant women in the United States have poorer cardiovascular health compared to non-pregnant women of a similar age. This gap may be widening over time.
Heart disease is one of the leading causes of death in pregnant women in the United States. Yet, knowledge about the overall heart health of pregnant women using the American Heart Association’s most up-to-date measurement tool, Life’s Essential 8 score, has been limited. Life’s Essential 8 score evaluates eight key factors, including diet, physical activity, sleep, smoking, body mass index, blood pressure, blood sugar and cholesterol.
To better understand heart health during pregnancy, researchers studied data from the National Health and Nutrition Examination Survey from 2011 to 2020, representing about 1.6 million pregnant women and 34.5 million non-pregnant women ages 20 to 44 who did not already have heart disease.
The results showed that pregnant women had worse overall heart health compared to non-pregnant women. The biggest drivers of the heart health gap were lower levels of physical activity, less favorable cholesterol profiles and higher body mass index among pregnant women.
“We know that pregnancy naturally changes a woman’s body and things like weight and blood sugar shift as part of a healthy pregnancy,” said Krishin Yerabolu, first author and medical student at UAB. “But even after accounting for those expected changes, pregnant women still had significantly worse heart health. This tells us that this gap is not just a normal part of being pregnant. Real, everyday factors, like staying active and eating well, impact heart health in pregnant women.”
Pregnant women were also 51 percent less likely to have ideal heart health.
Key Takeaways:
- Pregnant women have lower overall cardiovascular health compared to non-pregnant women
- Key health factors such as physical activity, diet and cholesterol levels, are worse during pregnancy
- The likelihood of achieving ideal cardiovascular health is significantly reduced during pregnancy
“Pregnancy represents a critical window for identifying and improving cardiovascular health, yet the women who need the best cardiovascular health are the ones falling behind,” said Garima Arora, M.D., senior author and medical director of Echocardiography. “This has consequences not just for mothers, but for their children as well. Improving these risk factors early can have long-term benefits for both mothers and their children.”
Co-author Pankaj Arora, M.D., director of the UAB Cardiogenomics Clinic, says that these findings can guide care practices to emphasize heart health in pregnant women.
“Integrating cardiovascular risk assessment into routine prenatal care is important,” Pankaj Arora said. “Ensuring all patients have access to early screening and prevention strategies is key to improving outcomes.”
According to the authors, future cardiovascular health scoring systems should incorporate pregnancy-specific thresholds, particularly for BMI and blood sugar, which change significantly across trimesters. Future research should also employ larger samples that better represent pregnant women to track these important trends over time.
Tips to maintain heart health during pregnancy
Harshvir S. Bal, M.D., a research fellow working under Arora and Yerabolu say pregnancy is an ideal time to build heart-healthy habits that benefit both women and their babies.
- Stay active: Aim for at least 20 to 30 minutes of moderate-intensity exercise, such as walking, swimming, or stationary cycling, on most days of the week. Regular physical activity during pregnancy helps manage blood pressure and blood sugar and has been shown to lower the risk of gestational diabetes. Always check with your doctor before starting or continuing an exercise program.
- Eat a heart-healthy diet: Focus on a balanced eating pattern rich in vegetables, fruits, whole grains, legumes, nuts and lean proteins. Limit processed foods, excess salt and added sugars. This eating pattern has been associated with lower blood pressure during pregnancy and may reduce the risk of preterm delivery and gestational diabetes.
- Avoid tobacco, nicotine and alcohol: Steer clear of all tobacco and nicotine products, including cigarettes, vapes and secondhand smoke. Smoking during pregnancy increases the risk of preterm birth, low birth weight, and long-term heart health problems for both mother and baby. Avoid alcohol entirely during pregnancy.
- Prioritize quality sleep: Aim for seven to nine hours of sleep each night. Good sleep supports a healthy heart and helps regulate blood pressure, blood sugar and metabolism. If you are experiencing common pregnancy-related sleep problems such as frequent waking, discomfort, or snoring, discuss them with your doctor, as these may affect your overall health.
- Keep up with prenatal visits: Regular prenatal check-ups allow doctors to monitor blood pressure, blood sugar and weight gain throughout pregnancy. These visits are a key opportunity to catch potential problems early and to create personalized plans.