Table 4.

Key Knowledge Gaps in Mechanistic Pathways, Effective Interventions, and Implementation of Strategies to Equitably Promote Pre-Pregnancy Cardiovascular Health

Pathophysiology	What are the pathophysiologic mechanisms and pathways linking pre-pregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease? Could proteomic markers assessed prior to pregnancy identify individuals at highest risk of adverse pregnancy outcomes for whom increased surveillance or intensive risk factor modification may reduce risk of APOs? Are there mechanistic targets that can inform novel therapeutic development to improve pre-pregnancy CVH and pregnancy outcomes?
Interventional Research	Which metrics of the CVH construct are most salient to target in a multi-component intervention in the pre-pregnancy period to improve maternal and offspring outcomes? Should thresholds for treatment of cardiovascular risk factors be different in pregnancy-capable individuals with hypertension (e.g., goal BP level <130/80 mm Hg vs. <140/90 mm Hg pre-pregnancy)? How should interventions be designed to incorporate and address social determinants of health, psychological health, and stress to improve pre-pregnancy CVH? How should we identify individuals at highest absolute risk (e.g., low CVH, biomarkers) to prioritize for testing interventions? Do interventions targeting the interpregnancy period improve outcomes of the subsequent pregnancy and offspring? Do interventions targeting pre-pregnancy CVH reduce the risk of long-term kidney disease?
Dissemination and Implementation Research	Is the proposed intervention adaptable for resource-limited populations? Is the proposed intervention culturally tailored to maximize benefit in diverse communities? Can technology-based approaches (e.g., virtual reminders, mHealth) optimize delivery of interventions to improve pre-pregnancy CVH?
Health Equity Considerations	Can healthcare system-based models that provide patient navigation and peer support to address barriers that exist help to optimize pre-pregnancy cardiovascular health? What are optimal strategies to ensure equitable recruitment of individuals who do not have routine healthcare access, particularly in the pre-pregnancy period? What strategies are most effective in engaging key stakeholders from communities from the beginning of intervention development to process improvement in the implementation phases? Are interventions generalizable to different populations, including across race and ethnicity, socioeconomic status, and gender identity?