Identifying cardiovascular health profiles in early pregnancy: A "Life's Essential 8"-based approach to assessing risk of hypertensive disorders of pregnancy

Chelsea A DeBolt; Rebecca M Cohen; Zhan Zhao; Katharine McCarthy; Kimberly B Glazer

doi:10.1016/j.preghy.2025.101260

Identifying cardiovascular health profiles in early pregnancy: A "Life's Essential 8"-based approach to assessing risk of hypertensive disorders of pregnancy

Pregnancy Hypertens. 2025 Oct 7:42:101260. doi: 10.1016/j.preghy.2025.101260. Online ahead of print.

Authors

Chelsea A DeBolt¹, Rebecca M Cohen², Zhan Zhao³, Katharine McCarthy⁴, Kimberly B Glazer⁵

Affiliations

¹ Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: chelsea.debolt@mssm.edu.
² Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁴ Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System & Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

PMID: 41066837
DOI: 10.1016/j.preghy.2025.101260

Abstract

Objectives: This study aimed to characterize cardiovascular risk profiles in an obstetric population using American Heart Association's Life's Essential 8 components and investigate which combinations are associated with hypertensive disorders of pregnancy (HDP).

Study design: Secondary analysis of a prospective observational cohort, Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b).

Main outcome measures: We used latent class analysis to identify cardiovascular risk classes using Life's Essential 8 indicators at 6-14 weeks' gestation: blood pressure (BP), body mass index (BMI), and self-reported diet, sleep, smoke exposure, and physical activity. We assessed predictors of class membership and odds of HDP with logistic regression.

Results: We identified a four-class solution with the following interpretative labels: (1) Healthy Behaviors/Normal BMI & BP (42%), (2) No Physical Activity/Normal BMI & BP (31%), (3) High Snoring/Elevated BMI (18%), and (4) Poor Behaviors/Normal BMI & BP (8%). Compared with the Healthy Behaviors/Normal BMI & BP class, individuals in the other risk profiles were more likely to be unmarried vs. married, Non-Hispanic Black vs. Non-Hispanic White, have government vs. commercial insurance, and report high vs. low periconceptual stress. Two risk profiles were associated with HDP: High Snoring/Elevated BMI had 2.4 times (95% CI 2.1-2.8) the odds and Poor Behaviors/Normal BMI & BP had 1.5 times (95% CI 1.2-1.8) the odds of HDP compared with Healthy Behaviors/Normal BMI & BP.

Conclusions: Two cardiovascular risk profiles-High Snoring/Elevated BMI and Poor Behaviors/Normal BMI & BP-were linked to HDP, emphasizing the potential for personalized, multifactorial interventions targeting modifiable behaviors to reduce risk.

Keywords: Body mass index; Healthy eating index; Obesity; Physical activity; Preeclampsia; Snoring.