Abstract P444: Pre-Pregnancy Substance Use and First Trimester Cardiovascular Health Among Nulliparous Pregnant People: The nuMoM2b Study

Introduction: Pre-pregnancy health, including substance use and cardiovascular risk factors, have been associated with higher risks of maternal-fetal morbidity and mortality. The objective of this study was to determine if pre-pregnancy substance use is associated with early pregnancy cardiovascular health (CVH). Hypothesis: Pre-pregnancy use of alcohol, tobacco, marijuana, or illicit substances are associated with worse CVH as early as the first trimester of pregnancy. Methods: This is a secondary analysis using data collected in the first trimester of pregnancy in the nuMoM2b cohort (n=9,895). Pre-pregnancy alcohol, tobacco, marijuana, and illicit substance use were assessed through standardized questionnaires. Latent class analysis categorized participants into four subgroups based on their reported pre-pregnancy substance use characteristics: [1] Illicit substances, marijuana, and alcohol use (n=1,234); [2] marijuana and alcohol use (n=2,066); [3] tobacco and alcohol use (n=636); and [4] alcohol use (n=3,194). Non-users were referent (n=2,765). CVH score was assessed using the American Heart Association Life’s Essential 8 (LE8) framework and included scoring of measured height, weight, resting blood pressure, blood glucose, and non-HDL cholesterol as well as self-reported diet, sleep, and exercise from 0 (least healthy) to 100 (most healthy). Multiple linear regression evaluated the relationship between pre-pregnancy substance use subgroups and LE8 score (overall and specific components). Results: Mean LE8 score varied by pre-pregnancy substance use subgroup: non-users Mean 65, SD ± 1.3, illicit substances, marijuana, and alcohol use 68 ± 1.3, marijuana and alcohol use 67 ± 1.3, tobacco and alcohol use 62 ± 1.4, and alcohol use 67 ± 1.3 (p<.0001). In adjusted models and compared to non-users, those who used tobacco and alcohol had a lower LE8 score (-2.8, p<.0001), other pre-pregnancy substance use classes had slightly higher scores ranging from 1.8-2.5 points (p<.0001). Similar patterns were observed for individual components of the LE8 score. Conclusion: Individuals who used tobacco and alcohol prior to pregnancy, as opposed to other substance use subgroups, begin pregnancy with worse cardiovascular risk and may benefit from CVH promotion efforts.