Life's Essential 8 in Pregnancy and Time to Incident Cardiometabolic Disease Over 7 Years Follow-Up

ImportanceAssessment of cardiovascular health (CVH) during may unmask latent metabolic vulnerability and indicate long-term disease risk. However, the prognostic value of the AHAs Lifes Essential 8 (LE8) framework during pregnancy remains uncertain. ObjectiveTo evaluate CVH during using a modified Lifes Essential 8 (mLE8) score in association with time to incident cardiometabolic disease. DesignProspective cohort study with electronic medical record (EMR) surveillance for 7 years postpartum (August 2018-March 2026). Adjusted accelerated time-to-failure models estimated mLE8 associations with incident conditions. SettingA population-based prenatal cohort recruited from a large academic medical system in South Carolina. ParticipantsSingleton pregnancies in individuals aged 18 to 44 years without pre-existing diabetes or cardiovascular disease (CVD) ExposuresA 7-component mLE8 score assessed during pregnancy, incorporating hypertensive disorders of pregnancy (HDP), 50-g glucose tolerance test results, pre-pregnancy body mass index, smoking status, sleep adequacy, diet quality, and physical activity. Scores ranged from 0 to 100, with higher scores indicating more favorable CVH. Main Outcomes and MeasuresPost-delivery incident cardiometabolic conditions captured through EMRs and classified as chronic hypertensive conditions, chronic metabolic conditions (e.g., dyslipidemia, impaired glucose regulation), and CVD (e.g. cardiac arrest, cardiomyopathy). Time to incident diagnosis was measured in days from delivery. ResultsAmong 1,225 pregnancies (mean age, 25.0 [5.3] years), 499 incident cardiometabolic events occurred over a median follow-up of 6.2 (2.8) years. Each 10-point higher mLE8 score was associated with a longer time to incident diagnosis of chronic hypertensive conditions (time ratio [TR], 1.26; 95% CI, 1.11-1.42) and chronic metabolic conditions (TR, 1.20; 95% CI, 1.11-1.29). Healthier HDP, glucose, BMI, and sleep scores were most strongly associated with longer time to diagnosis of chronic metabolic disease. Results were robust to sensitivity analyses excluding individuals who developed gestational diabetes or HDP. Conclusions and RelevanceIn this racially diverse, low-income cohort study of 1,225 pregnancies, better CVH during pregnancy was associated with a longer time to incident post-delivery diagnosis of cardiometabolic conditions. Pregnancy-based CVH assessment may help identify individuals with elevated and emerging cardiometabolic risk who could benefit from early, targeted intervention and enhanced longitudinal surveillance. Key PointsQuestion: Is cardiovascular health during pregnancy, assessed using a modified Lifes Essential 8 score (LE8), associated with time to incident cardiometabolic disease after pregnancy? Findings: In a racially diverse prospective pregnancy cohort with 7 years of electronic medical record follow-up, healthier mLE8 scores were associated with a significantly longer time to diagnosis of chronic hypertension and metabolic conditions. Associations persisted after excluding individuals with gestational diabetes or hypertensive disorders of pregnancy. Meaning: Pregnancy cardiovascular health assessment using LE8 may identify individuals with elevated risk and latent vulnerability, and support earlier intervention during a sensitive window for prevention of long-term cardiometabolic disease.