Pregnancy complications may increase future heart disease risk

Pregnancy complications may increase future heart disease risk | Image Credit: © Ngampol - © Ngampol - stock.adobe.com.

Pregnancy complications may raise long-term cardiovascular disease risk

The risk of cardiovascular disease (CVD) later in life may be impacted by complications during pregnancy such as gestational diabetes and newly developed high blood pressure among overweight women, according to a recent study published in JACC, journal of the American College of Cardiology.¹

The study was conducted to determine whether pregnancy complications are directly linked to CVD risk or serve as a marker of underlying factors associated with the condition. Based on the data, maternal health and future cardiovascular risk may be improved through weight management before pregnancy.¹

Importance of early intervention

“Understanding the connection between adverse pregnancy outcomes and cardiovascular disease is important in the development of effective preventative strategies and determining the best timing for intervention to support long-term heart health,” said Jaclyn Borrowman, PhD, researcher at Northwestern University and the study’s lead author.¹

According to Borrowman, complications during pregnancy often indicate risks of future health outcomes, including a 2-fold to 4-fold increased risk of CVD. Approximately 20% of US pregnancies are impacted by complications, highlighting the need to evaluate associated outcomes.¹

Study design and key cardiovascular risk factors

Women aged at least 18 years without pregnancy hypertension or diabetes were enrolled at 28-weeks’ gestation.² Follow-up occurred at 11.6 ± 1.3 years following birth, with assessments performed for the link between self-reported prepregnancy body mass index (BMI) and CVD risk factors.

Relevant CVD risk factors included mean arterial pressure (MAP), triglycerides, and hemoglobin A1c (HbA1c) mediated by gestational diabetes (GDM) and new-onset hypertensive disorders of pregnancy (HDP). Adjustments were made for parity, maternal and gestational age, alcohol and smoking status, field center, and fetal sex.²

Population and associations with pregnancy complications

There were 4269 patients aged a mean 30.1 ± 5.6 years at birth included in the analysis. Prepregnancy obesity was reported in 10.6% of these patients, GDM in 13.8%, and new-onset HDP in 10.7%.²

Increased MAP, triglycerides, and HbA1c were reported at follow-up among patients with prepregnancy obesity vs normal BMI, at 7 mm Hg, 28.5 mg/dL, and 0.3%, respectively. The link between obesity and HbA1c was slightly mediated by GDM, at 24.6%.²

Role of mediation by pregnancy complications

A mediating factor was also reported for new-onset, HDP, mediating the link between obesity and MAP at 12.4%. Overall, links between prepregnancy BMI and future CVD risk were mediated by adverse pregnancy outcomes, highlighting the benefits of promoting weight management earlier in life.²

According to Borrowman, while the link between prepregnancy BMI and CVD risk is partially influenced by complications during pregnancy, most of the connection is influenced by other factors.¹ However, this data may be used to guide screening, counseling, and management.

Implications

Future research may be conducted to evaluate the association between cardiovascular health early in pregnancy and complications incidence. This may allow for the identification of interventions that can decrease the risk of CVD and improve maternal health.

“The study highlights the significance of adverse pregnancy outcomes as a risk-enhancing factor for cardiovascular disease,” said Borrowman. “Our results also suggest that prioritizing weight management among those considering pregnancy may promote both maternal and future cardiovascular health.”¹

References

1. Pregnancy complications contribute to cardiovascular risk for overweight women, study finds. American College of Cardiology. April 14, 2024. Accessed April 15, 2025. https://www.eurekalert.org/news-releases/1080015.
2. Borrowman JD, Huang X, Petito LC, et al. Prepregnancy adiposity, adverse pregnancy outcomes, and cardiovascular disease risk in midlife. JACC. 2025;85(15):1536–1546.