Study: 60% of U.S. Women Have Poor Heart Health Before Pregnancy

A new analysis of more than 14 million American births reveals a troubling baseline: only four in ten women who gave birth in 2019 entered pregnancy in good cardiovascular health. The rest carried at least one significant risk factor—excess weight, high blood pressure, or diabetes—conditions that threaten not only the pregnancy itself but the lifelong health of the child being born.

The research, published in Circulation by the American Heart Association, tracked women ages 20 to 44 who delivered live babies between 2016 and 2019. Optimal heart health was defined simply: a normal body weight and no diagnosis of hypertension or diabetes. By that measure, the proportion of women meeting that standard slipped from 43.5 percent in 2016 to 40.2 percent in 2019—a decline of more than three percentage points in just three years. Excess weight emerged as the dominant culprit, though high blood pressure and diabetes also played significant roles.

The stakes are not abstract. Heart disease accounts for more than one in four pregnancy-related deaths, according to the American Heart Association's 2022 statistics. Beyond mortality, poor maternal cardiovascular health correlates with immediate complications: babies born prematurely, infants arriving smaller than expected for their gestational age. The damage extends further still. Children born to mothers with compromised heart health show signs of poor cardiovascular health themselves years later, a connection that surprised many researchers and clinicians. Pregnancy, as one cardiologist noted, functions as a stress test on the body—the heart must work harder, circulation intensifies, and a woman's system bears an extraordinary burden. Those already struggling with weight, blood pressure, or blood sugar enter that crucible unprepared.

Geography matters. Women in Mississippi had the lowest rates of good pre-pregnancy heart health at 31.2 percent, while Utah led at 47.2 percent. The South and Midwest lagged behind the West and Northeast. These patterns mirror the geographic distribution of heart disease and stroke across the general population, suggesting that something deeper than individual choice is at work. The researchers point to social determinants of health: educational attainment, access to Medicaid, proximity to preventive care, the ability to afford nutritious food, the character of one's neighborhood. Poverty and geography conspire to make heart health a luxury many women cannot afford before they become pregnant.

Many women never see a doctor regularly until they become pregnant. By then, conditions like obesity or hypertension may already be entrenched, harder to manage, and potentially damaging to the developing fetus. If these conditions were identified and treated beforehand, clinicians could help women optimize their health before conception—a shift that would benefit both mother and child across decades. Yet nearly half of pregnancies are unplanned, meaning that cardiovascular health in young adulthood matters even for women who are not yet thinking about motherhood.

The researchers are calling for change at a scale beyond individual behavior. They want federal and state policies that guarantee equitable access to preventive care before, during, and after pregnancy. They want economic investment in communities—green spaces for exercise, access to affordable heart-healthy food, the infrastructure that makes healthy living possible rather than a privilege. The conversation, they argue, must shift from asking what women can do to asking what society can do to support them. Future research will dig into the specific economic and social factors driving state-level disparities, knowledge that could help tailor interventions to improve the heart health of women and their children across generations.