Maternal Heart Health Starts at Home (MomHeart): Targeting Place-Based Social Needs to Improve Pregnancy and Postpartum Cardiovascular Health - Modified Project Summary/Abstract Section Adverse cardiovascular health (CVH) is the leading cause of pregnancy-related deaths in the US, which have increased 140% over the past three decades. Adverse CVH disproportionately affects pregnant women who have greater non-medical needs (e.g., lack of adequate nutrition) and directly contributes to differences in maternal CVH. Non-medical needs should be understood as a multi-dimensional construct to be measured and intervened upon at multiple levels, including at both the individual and neighborhood level. Individual-level factors include housing insecurity, lack of access to quality healthcare, and inadequate insurance. Neighborhood-level factors include lack of access to transportation, proximity to healthcare facilities, and access to healthy foods and spaces to exercise. A woman’s experiences, which are shaped by these non-medical needs, directly impact CVH across the lifespan, including during pregnancy and the postpartum. Yet, during this important moment in a woman’s life, the relationship of non-medical needs with adverse CVH, including clinical factors, adverse pregnancy outcomes (APOs), and ultimately, cardiovascular disease (CVD) remains uncertain. In addition, neighborhood non-medical needs remain poorly characterized and understood during pregnancy and the postpartum. Healthy People 2030, professional recommendations, and NHLBI’s Strategic Vision Implementation Plan emphasize that effective population-level interventions and policies to improve CVH require a mechanistic, holistic, and integrated approach. Efforts to quantify the influence of non-medical needs on CVH have largely failed because the causal pathways are numerous, interconnected, and complex. A promising approach to test the inter-relationships of multiple non-medical needs over time is a polysocial risk score. We will harness the prospective nuMoM2b nulliparous pregnancy cohort (nuMoM2b) and the ongoing postpartum follow-up nuMoM2b Heart Health Study (HHS). This contemporary, generalizable, and deeply phenotyped population includes >10,000 women during their first birth experience from across eight US centers. We will employ contemporary theoretical frameworks, machine learning, advanced Bayesian methods, and participant-engaged data walks to construct concepts, identify relationships, and shape future policy and multi-level interventions that improve maternal CVH. Our premise in MomHeart is that maternal CVH is spatially patterned by multiple, intersecting factors in the peripartum period. We will accomplish three complementary specific aims: 1: Determine associations of individual non-medical needs and neighborhood factors that are associated with maternal CVH (clinical factors, APOs, composite CVH, and predicted CVD risk), cross-sectionally and longitudinally; 2: Examine the interconnection of individual non-medical needs and neighborhood factors through a polysocial risk score and examine the associations between a polysocial risk score and maternal CVH; and 3: Conduct qualitative interviews with active nuMoM2b-HHS participants to elucidate perspectives on how the patterns discerned have relevance to their own CVH and could serve as intervention points to improve maternal CVH. MomHeart will shape the future of precise and targeted interventions to enhance the CVH of the highest risk pregnant and postpartum women.
