Race and Ethnicity Disparities in the Life's Essential 8 Ever-Pregnant Adults in the United States: The National Health and Nutrition Examination Survey 2011-2020

BackgroundCardiometabolic conditions are among the leading causes of maternal mortality in the US. The American Heart Association (AHA) Lifes Essential 8TM (LE8) provides an actionable summary measure for assessing cardiovascular health. MethodsWe conducted a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data among ever-pregnant adults from 2011 through March 2020. The exposure of interest was race/ethnicity. Primary outcomes included LE8 scores (health outcome and lifestyle metrics). We fitted survey-weighted linear and multinomial logistic regression models, examining racial and ethnic disparities by LE8 scores and each metric separately, adjusting for confounders. ResultsAmong 2,208 ever-pregnant adults, the mean age was 52.0 {+/-} 19.64 years. Non- Hispanic (NH) Black adults had lower mean LE8 scores (57.20 95%CI: 55.96, 58.44) compared to NH White (62.85 95% CI: 61.39, 64.30), Mexican/Hispanic (62.26, 95%CI 60.86, 63.66), and NH Asian adults (65.83 95% CI: 63.47, 68.19). After adjusting for confounders, NH Black adults had significantly lower overall LE8 scores than NH White adults ({beta} = -0.09, 95% CI: -0.12, -0.06), with lower scores for blood pressure ({beta} = -0.25, 95% CI: -0.32, -0.18) and BMI ({beta} = -0.21, 95% CI: -0.30, -0.11). Mexican/Hispanic adults were less likely to be in the high LE8 score category (Quartile 3) compared to NH White adults (PRR: 1.32, 95% CI: 0.92 1.91) and had lower physical activity scores ({beta} = -0.38, 95% CI: -0.55, -0.21). NH Asian adults had lower scores for physical activity ({beta} = -0.76, 95% CI: -1.10, -0.4) but higher scores for BMI ({beta} = 0.31, 95% CI: 0.23, 0.40). ConclusionNH Black, Hispanic ever-pregnant adults had a higher prevalence of adverse cardiometabolic outcomes. Focused interventions are needed to address these disparities and improve maternal cardiometabolic health, per AHAs LE8 goals. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LIThe Lifes Essential 8 (LE8) score provides a comprehensive and actionable tool for assessing cardiovascular health in ever-pregnant adults, offering clinicians a standardized method to identify and stratify cardiovascular risk. C_LIO_LISignificant racial and ethnic disparities exist in LE8 scores among ever- pregnant adults, with NH Black women consistently showing lower scores across various components, indicating a higher burden of cardiovascular risk factors. C_LIO_LIHigher education levels and socioeconomic status are strongly associated with better LE8 scores, highlighting the importance of addressing social determinants of health in cardiovascular risk management. C_LI What Are the Clinical Implications?O_LILE8 score can be used alongside existing risk assessment tools to better identify women at high risk for cardiometabolic complications during pregnancy. This allows for earlier intervention and potentially improved maternal health outcomes. C_LIO_LIFor women identified with lower LE8 scores, early intervention becomes crucial. C_LIO_LIPreconception care programs can help optimize their cardiovascular health before pregnancy by promoting healthy diets, physical activity, and weight management. C_LIO_LIThe link between lower LE8 scores and lower socioeconomic status underscores the importance of addressing social determinants of health. C_LI