Cardiovascular Health of Single Mothers: A Systematic Review

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Abstract
Background: Social drivers of health shape cardiovascular health (CVH), with single mothers facing considerable social adversity. This review aimed to describe single mothers’ CVH and the potential role of social drivers of health. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, we included observational studies published in English that assessed at least 1 American Heart Association–defined CVH factor or behavior among parous single mothers (aged >18 years). Searches were conducted in 3 electronic databases, with 2 reviewers independently screening. Study quality and risk of bias were assessed using the Appraisal Tool for Cross‐Sectional Studies and the Risk of Bias in Nonrandomized Studies of Exposures. Results: Of 2071 search results, 1704 articles were screened, and 36 studies met inclusion criteria. Most studies were cross‐sectional (n=33), with diet and nicotine use the most assessed outcomes (n=26), followed by physical activity (n=9), body mass index (n=7), sleep (n=6), blood pressure (n=4), blood glucose (n=3), and blood lipids (n=2). Overall, findings suggest that single mothers have worse CVH behaviors and factors compared with partnered mothers. Social drivers of health influences were rarely examined with individual‐level factors (eg, income) most common (n=7) and structural‐level factors (eg, access to food outlets) were least (n=1). Conclusions: The present review suggests that single mothers have worse CVH compared with partnered mothers. More research is needed to identify potential drivers of poor CVH among single mothers to inform interventions targeting specific health behaviors or factors to decrease cardiovascular disease risk. Critically, future studies should examine structural‐level social drivers of health through an intersectional lens to advance health equity for single mothers.

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