Satti Danish Iltaf, Chan Jeffrey Shi Kai, Metlock Faith E, Mszar Reed, Mehta Adhya, Chan Raymond Ngai Chiu, Chang Ryan, Spitz Jared, Saad Antonio, Gaffey Allison E, Javed Zulqarnain, Dastmalchi Lily Nedda, Mehta Anurag, Powell-Wiley Tiffany, Sharma Garima
Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China.
JACC Adv. 2025 Mar 27;4(5):101683. doi: 10.1016/j.jacadv.2025.101683.
The relationship between psychological health and cardiovascular health (CVH) during pregnancy is not well characterized.
The purpose of this study was to perform a cross-sectional analysis in order to assess the relationships between psychological distress and CVH among pregnant individuals in the United States.
U.S. National Health Interview Survey (2013-2018) data were used for the analyses. The sample included all pregnant participants aged ≥18 years, but excluded those with missing data for the exposure, outcome, or covariates. Psychological health was measured with the 6-item Kessler scale, and severe psychological distress was defined as 6-item Kessler scale ≥13. CVH was quantified using the American Heart Association's Life's Essential 8; as detailed dietary data were unavailable, a 7-item score was used (higher scores indicated worse CVH). Multivariable Poisson regression tested associations between severe psychological distress and CVH, adjusting for potential confounders including age, race/ethnicity, sexual orientation, education level, family income, any known cardiovascular conditions, and insurance.
Among 1,110 pregnant individuals (representing >1.5 million pregnant individuals each year of the survey), 3.5% reported severe psychological distress (95% CI: 2.2%-5.5%), 21.7% reported moderate psychological distress (95% CI: 18.8%-24.9%), and 74.9% reported either mild or no psychological distress (95% CI: 71.4%-78.0%). Individuals reporting moderate psychological distress (adjusted rate ratio: 1.25 [95% CI: 1.13-1.38], P < 0.001) or severe psychological distress (adjusted rate ratio: 1.42 [95% CI: 1.20-1.68], P < 0.001) had lower CVH scores compared to those with mild or no psychological distress. A stepwise relation was observed between the severity of psychological distress and CVH.
We observed a strong association between psychological distress and suboptimal CVH during pregnancy, highlighting the need to manage psychological health along with CVH in pregnant individuals.
孕期心理健康与心血管健康（CVH）之间的关系尚未得到充分描述。
本研究旨在进行横断面分析，以评估美国孕妇心理困扰与CVH之间的关系。
分析使用了美国国家健康访谈调查（2013 - 2018年）的数据。样本包括所有年龄≥18岁的孕妇，但排除了暴露、结局或协变量数据缺失的个体。心理健康用6项凯斯勒量表进行测量，严重心理困扰定义为6项凯斯勒量表得分≥13。CVH使用美国心脏协会的生命八大要素进行量化；由于无法获得详细的饮食数据，使用了7项评分（分数越高表明CVH越差）。多变量泊松回归检验了严重心理困扰与CVH之间的关联，并对包括年龄、种族/民族、性取向、教育水平、家庭收入、任何已知的心血管疾病和保险等潜在混杂因素进行了调整。
在1110名孕妇中（代表调查期间每年超过150万孕妇），3.5%报告有严重心理困扰（95%置信区间：2.2% - 5.5%），21.7%报告有中度心理困扰（95%置信区间：18.8% - 24.9%），74.9%报告有轻度或无心理困扰（95%置信区间：71.4% - 78.0%）。与有轻度或无心理困扰的孕妇相比，报告有中度心理困扰的孕妇（调整率比：1.25 [95%置信区间：1.13 - 1.38]，P < 0.001）或严重心理困扰的孕妇（调整率比：1.42 [95%置信区间：1.20 - 1.68]，P < 0.001）的CVH得分较低。观察到心理困扰严重程度与CVH之间存在逐步关系。
我们观察到孕期心理困扰与次优CVH之间存在密切关联，这突出了在孕妇中同时管理心理健康和CVH的必要性。
