How improving education could close maternal heart health gaps

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How improving education could close maternal heart health gaps

Northwestern study examines how social, environmental factors drive disparities in heart health for Black and Hispanic mothers

• Link to: Northwestern Now Story

• Social factors, not biology, explain nearly all racial disparities in maternal heart health

CHICAGO --- Research has established a clear link between racial and ethnic disparities in maternal heart health and higher risks of preterm birth, preeclampsia and cardiovascular issues for Black and Hispanic mothers and their babies.

Now, a new Northwestern study dives deeper into these disparities and discovered a powerful insight: achieving equity in various social drivers of health - but particularly education - could nearly eliminate these gaps. Additional education, along with factors such as income and access to healthcare, could reduce the heart health gap between Black and white women by 82% and erase it entirely between Hispanic and white women.

In other words, social and environmental factors - not biological differences at birth - drive steep disparities in cardiovascular health during pregnancy.

The study published on Jan. 14 in Circulation: Cardiovascular Quality and Outcomes.

"If racial and ethnic groups achieved the same average years of education, the gaps in heart health between the groups could be substantially reduced," said first author Dr. Natalie Cameron, an instructor of general internal medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.

"The pathways linking education to heart health are complex and may be related to income, health insurance, access to health care and health-related knowledge," Cameron added.

How the study was done

Northwestern scientists analyzed data collected during the beginning of pregnancy from 9,104 participants in the Nulliparous Pregnancy Outcomes Study, who self-identified as Hispanic, non-Hispanic Black or non-Hispanic white.

The team began by calculating participants' cardiovascular health scores, which were based on six factors: blood pressure, body weight, exercise levels, diet, smoking behavior and sleep. They then determined how these scores differed between the groups.

To explore what drove the differences, the scientists analyzed self-reported data on individual and neighborhood-level factors such as maternal age, education, income, health insurance, mental health, racial discrimination and neighborhood deprivation.

Using statistical methods, the scientists found that the individual- and

neighborhood-level factors explained all differences in cardiovascular health between Hispanic and white participants, and 82% of the differences between Black and white participants.

The scientists also found that educational attainment had the largest impact on maternal cardiovascular health disparities.

Call for action

These findings support a growing body of literature emphasizing the power that social and environmental factors have on health. Other Northwestern scientists recently calculated similar results in non-pregnant populations.

Cameron says reform is needed at multiple levels to address racial and ethnic differences in heart health, starting even before pregnancy.

"From a public health standpoint, we need to improve access to healthy foods, build environments where people can safely walk and play and improve access to preventive healthcare. Researchers and policy makers need to partner with communities to make sure these changes are implemented in ways that support their neighborhoods and wellbeing."

Cameron adds that healthcare systems and providers must play an active role in screening for social determinants of health early in life, before pregnancy.

"If a specific need is identified, providers can connect patients with social workers and community resources to help address these needs," she said.

With the new findings in mind, Cameron says the next steps are to "design, implement and test the effectiveness of programs that address these social and environmental factors in improving heart health before pregnancy."

The study was supported by the National Institutes of Health/National Heart Lung and Blood Institute (R01 HL161514).