Adverse Physical Environment, Housing, and Economic Conditions: Their Impact on Maternal Cardiovascular Health During and Post-Pregnancy

Author(s):

Oluwaremilekun Zeth Tolu-Akinnawo*, Anderson Anuforo, Joshua Olajide, Francis Ezekwueme, Toluwalase Awoyemi

Background: Maternal cardiovascular health is a critical public health priority, particularly during pregnancy and the postpartum period. While the broader influence of social determinants on health is well documented, the specific contributions of adverse physical environment, housing instability, and economic hardship to maternal cardiovascular outcomes remain inadequately characterized. Materials and methods: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network to evaluate the association between adverse social determinants, specifically physical environment, housing, and economic conditions (ICD-10-CM: Z58, Z59), and maternal cardiovascular outcomes during pregnancy and up to one year postpartum. Women aged 15-60 with documented adverse exposures between 2008 and 2023 were propensity score matched (1:1) to a control cohort without such exposures. Primary outcomes included all-cause mortality, Acute Myocardial Infarction (AMI), Major Adverse Cardiac And Cerebrovascular Events (MACCE), ischemic stroke, and select pregnancy-related cardiovascular complications. Results: Exposure to adverse physical, housing, and economic conditions was significantly associated with elevated risk of all-cause mortality (OR: 3.24; 95% CI: 2.06-5.08; p<0.001), AMI (OR: 2.83; 95% CI: 1.42-5.63; p=0.002), MACCE (OR: 2.73; 95% CI: 1.95-3.78; p<0.001), and ischemic stroke (OR: 2.08; 95% CI: 1.07-4.04; p=0.026). No significant associations were observed with peripartum/postpartum preeclampsia, eclampsia, hemorrhagic stroke, or peripartum cardiomyopathy. Conclusion: Adverse physical environment, housing instability, and economic hardship are significantly associated with increased risk of major cardiovascular events and mortality among pregnant and postpartum women. These findings underscore the need for targeted public health interventions and policy efforts to address upstream social determinants as a strategy to improve maternal cardiovascular health outcomes.