Abstract Body (Do not enter title and authors here): Background: Racial and ethnic disparities exist in cardiovascular health (CVH) in pregnancy. While social determinants of health (SDOH) affect CVH, the extent to which SDOH assessed in early pregnancy explain racial and ethnic differences in CVH postpartum remains to be defined.

Objective: This study examines the relative contribution of SDOH in early pregnancy to racial and ethnic differences in maternal CVH 2-7 years after delivery.

Methods: This is a secondary analysis of the prospective nulliparous pregnancy outcomes study: Monitoring Mothers-to-be Heart Health Study (nuMoM2b-HHS) cohort. The outcome was maternal CVH defined using the American Heart Association’s Life’s Essential 8 (LE8) framework, which included body mass index, blood pressure, lipids, fasting glucose, diet, physical activity, sleep health, and smoking status, and calculated as a score of 0-100. We used the Blinder-Oaxaca decomposition to quantify the statistical contributions of differences in demographic (age and nativity), socioeconomic status ([SES], education, income, insurance, and health literacy), and psychosocial (resilience, social support, anxiety, depression, and stress) factors in early pregnancy to differences in mean postpartum CVH between the two largest self-identified minoritized racial and ethnic groups (non-Hispanic [NH] Black and Hispanic) and NH White individuals.

Results: Of 4,161 assessed pregnant individuals, 17.7% identified as Hispanic, 15% as Black, and 67.3% as White. After adjusting for demographic, SES, and psychosocial factors, the average CVH score in White individuals was 12.2 (SE 1.2) points higher (better) than in Black individuals and 3.3 (SE 0.8) points higher than in Hispanic individuals (Figure, all p<0.001). If the distribution of SES factors among Black and Hispanic individuals were similar to White individuals, the CVH score would be 6.6 (SE 0.8) points higher (better) in Black individuals (i.e., 50% of the CVH difference) and 3.9 (SE 0.6) points higher in Hispanic individuals (i.e., 100% of the CVH difference).

Conclusions: The majority of racial and ethnic differences in CVH 2-7 years after delivery were explained by differences in SES factors present in early pregnancy. Public health and structural policies that target SES factors in or before pregnancy may reduce racial and ethnic disparities in postpartum maternal CVH.