Maternal Cardiovascular Inequalities Widen With Age

RACIAL and socioeconomic inequalities in maternal cardiovascular health may become increasingly pronounced with age, according to a large US study of nearly 1.9 million births.

Researchers found that age-related increases in adverse cardiometabolic outcomes were greater among Black women than White women across socioeconomic groups, with the steepest increases observed among Black women experiencing greater socioeconomic disadvantage.

Tracking Cardiovascular Risk Across 1.9 Million Births

The cross-sectional study analysed 1,880,400 births in California between 2007 and 2019, including live births and stillbirths occurring at 20 weeks of gestation or later.

Researchers examined maternal age alongside race, ethnicity, education and insurance status. Outcomes included hypertensive disorders of pregnancy, chronic hypertension, gestational hypertension or pre-eclampsia, and measures of cardiovascular health before and during pregnancy.

Overall, hypertensive disorders of pregnancy occurred in 14.2% of births among Black women compared with 9.2% among White women. Non-optimal pre-pregnancy cardiovascular health was also more common among Black women, affecting 60.9% compared with 45.2% of White women.

Age-Related Disparities

Across socioeconomic categories, adverse cardiometabolic risk increased more sharply with age among Black women.

For example, every 5-year increase in age among college-educated Black women was associated with a 27% greater risk of hypertensive disorders of pregnancy. Among White women with a high-school education or less, the corresponding increase was 23%.

Socioeconomic advantage did not eliminate the disparity. Black women with higher socioeconomic status experienced equivalent or greater age-related risk than White women in more socioeconomically disadvantaged groups.

The association was particularly pronounced for chronic hypertension. Among Black women with a high-school education or less, each 5-year increase in age was associated with a 79% increase in risk. The corresponding increase among college-educated White women was 41%.

Addressing Structural Drivers Earlier

The findings support the concept of ‘weathering’, whereby cumulative exposure to social and structural adversity may contribute to accelerated deterioration in health over the life course.

As a cross-sectional observational study, the analysis cannot establish that structural or socioeconomic factors directly caused the observed cardiovascular differences. However, the researchers argue that maternal cardiovascular inequalities cannot be understood through age, race or socioeconomic status independently.

They conclude that interventions addressing structural determinants and chronic stressors earlier in life may be necessary to reduce persistent inequalities in maternal cardiovascular health.

Reference

Hailu EM et al. Intersectional inequities in age-related risk of adverse maternal cardiometabolic health. JAMA Cardiol. 2026. doi:10.1001/jamacardio.2026.3051.

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