CirculationAHA SCIENTIFIC STATEMENTOptimizing Prepregnancy CardiovascularHealth to Improve Outcomes in Pregnant andPostpartum Individuals and Offspring:A ScientificStatement From the American Heart AssociationSadiya S.Khan,MD,MSc,FAHA,Chair;LaPrincess C.Brewer,MD,MPH;Mary M.Canobbio,RN,MN,FAHA;Marilyn J.Cipolla,PhD,FAHA;William A.Grobman,MD,MBA;Jennifer Lewey,MD,MPH;Erin D.Michos MD,MHS;Eliza C.Miller,MD,MS;Amanda M.Perak,MD,MS,FAHA;Gina S.Wei,MD,MPH,FAHA;Holly Gooding,MD,MSc Vice Chair;on behalf of the American Heart Association Council on Epidemiology and Prevention;Council on Clinical Cardiology;Councilon Cardiovascular and Stroke Nursing;Council on Arteriosclerosis,Thrombosis and Vascular Biology;Council on Hypertension;Council on Lifestyle and Cardiometabolic Health;Council on Peripheral Vascular Disease;and Stroke CouncilABSTRACT:This scientific statement summarizes the available preclinical,epidemiological,and clinical trial evidence thatsupports the contributions of prepregnancy (and interpregnancy)cardiovascular health to risk of adverse pregnancyoutcomes and cardiovascular disease in birthing individuals and offspring.Unfavorable cardiovascular health,as originallydefined by the American Heart Association in 2010 and revised in 2022,is prevalent in reproductive-aged individuals.Significant disparities exist in ideal cardiovascular health by race and ethnicity,socioeconomic status,and geography.Because the biological processes leading to adverse pregnancy outcomes begin before conception,interventionsfocused only during pregnancy may have limited impact on both the pregnant individual and offspring.Therefore,focusedattention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed.Thisscientific statement applies a life course and intergenerational framework to measure,modify,and monitor prepregnancycardiovascular health.All clinicians who interact with pregnancy-capable individuals can emphasize optimization ofcardiovascular health beginning early in childhood.Clinical trials are needed to investigate prepregnancy interventions tocomprehensively target cardiovascular health.Beyond individual-level interventions,community-level interventions mustinclude and engage key stakeholders (eg,community leaders,birthing individuals,families)and target a broad range ofantecedent psychosocial and social determinants.In addition,policy-level changes are needed to dismantle structuralracism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals haveinadequate,fragmented health care before and after pregnancy and between pregnancies(interpregnancy).Leveragingthese opportunities to target cardiovascular health has the potential to improve health across the life course and forsubsequent generations.Key Words:AHA Scientific Statements cardiovascular diseases pregnancy pregnancy complications primary prevention risk factorshere is a growing burden of cardiov
