Life’s Essential 8 in Pregnancy and Time to Incident Cardiometabolic Disease Over 7 Years Follow-Up
Ellen C. Francis, Shalin Patel, Anushka Pande, Alexa Freedman, Lauren Keenan-Devlin, Linda M. Ernst, Emily S. Barrett, Ann Borders, Gregory E. Miller, Shristi Rawal, Amy H. CrockettImportance
Assessment of cardiovascular health (CVH) during pregnancy may unmask latent metabolic vulnerability and indicate long-term disease risk. However, the prognostic value of the American Heart Association’s Life’s Essential 8 (LE8) framework during pregnancy remains uncertain.
Objective
To evaluate CVH during pregnancy using a modified LE8 (mLE8) score in association with time to incident cardiometabolic disease.
Design, Setting, and Participants
This cohort study used electronic medical record (EMR) surveillance for 7 years post partum (August 2018 to March 2026) and included singleton pregnancies in individuals aged 18 to 44 years without preexisting diabetes or cardiovascular disease (CVD) from a large academic medical system in South Carolina. Data were analyzed from December 2024 to April 2026.
Exposures
A 7-component mLE8 score assessed during pregnancy, incorporating hypertensive disorders of pregnancy (HDP), 50 g glucose tolerance test results, early 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 Measures
Postdelivery incident cardiometabolic conditions captured through EMRs and classified as chronic hypertensive conditions, chronic metabolic conditions (eg, dyslipidemia, impaired glucose regulation), and CVD (eg, cardiac arrest, cardiomyopathy). Adjusted accelerated time-to-failure models estimated mLE8 associations with incident conditions. Time to incident diagnosis was measured in days from delivery.
Results
Among 1225 pregnancies (mean [SD] age, 25.0 [5.3] years), 499 incident cardiometabolic events occurred over a median (IQR) 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 (1.06 [1.03-1.10]), glucose (1.15 [1.10-1.21]), body mass index (1.07 [1.04-1.11]), and sleep (1.05 [1.00-1.09]) scores were associated with longer time to diagnosis of chronic metabolic conditions. Associations were generally similar after excluding individuals with gestational diabetes or HDP.
Conclusions and Relevance
In this cohort study of 1225 pregnancies, better CVH during pregnancy was associated with a longer time to incident postdelivery 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.