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Less than half of U.S. women entering pregnancy have good heart health, and those rates are falling, according to new research.

Experts already knew poor heart health can have dire consequences for mothers-to-be. Cardiovascular disease is the leading cause of a mother's death during pregnancy and postpartum, making up 26.5% of pregnancy-related deaths, .

The new study sought to find out if heart health was declining before women became pregnant, and if so, in which parts of the country.

Researchers looked at data from all U.S. women, ages 20-44, who gave birth from 2016 to 2018. Then they zoomed in on how many of them had "favorable cardiometabolic health" before pregnancy, which was defined as having a normal weight and blood pressure and not having diabetes.

They found the percentage of women entering pregnancy with good heart health decreased during the study period, from 43.5% to 41.3%.

"I was quite surprised by those numbers," said researcher Natalie A. Cameron. "Our rates and trends were mostly driven by overweight and obesity. However, up to 4% to 5% of women in some states had two or more risk factors, demonstrating an important contribution of diabetes and hypertension to unfavorable health prior to pregnancy."

Presented last week at the ľ¹ÏÖ±²¥'s virtual Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference, the are considered preliminary until published in a peer-reviewed journal.

The study found every state experienced a drop in the rate of favorable pre-pregnancy heart health, but there was a major gap in different parts of the country. In 2018, about 33% of women in Mississippi had good pre-pregnancy hearth health compared to 48% in Utah.

Improving women's cardiovascular health before pregnancy is important for babies as well as moms. Being overweight or having obesity, diabetes or high blood pressure can lead to low birth weight for babies and higher health risks during adolescence, Cameron said.

While the study didn't explore the causes of poor heart health before pregnancy, the results show the need for a major shift in health care, she said.

"We need to investigate the barriers to promoting cardiometabolic health in the U.S.," said Cameron, a resident physician of internal medicine at the McGaw Medical Center of Northwestern University in Chicago. "Some of these barriers may include lack of access to health insurance, health care providers, healthy foods and safe places to walk and stay active."

Dr. Melinda Davis, a cardiologist who was not involved in the research, called it "an important study that shows the public and the medical community that we need to focus more on helping women achieve better overall health."

She said changes are needed in health policy aimed at reducing rates of obesity, high blood pressure and diabetes in young women. It's also essential for women be proactive about their health, she said.

"While it is important for all of us to make sure we are exercising, following a healthy diet, and managing any risk factors for heart disease, it is especially important for women who are planning to become pregnant," said Davis, assistant professor of cardiovascular medicine and part of a maternal heart team at the University of Michigan in Ann Arbor.

"I would encourage women to talk with their doctor before becoming pregnant to find out about any risk factors they may have and see how they can decrease their risk."

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