Can Pregnancy Reveal a Woman's Future Heart Disease Risk?

Could complications during pregnancy provide early warning signs of heart disease years before symptoms appear? New research suggests that a woman's pregnancy history may offer valuable clues about her lifelong cardiovascular health.

Pregnancy represents a unique period in a woman's life, during which the body undergoes substantial physiological changes. Beyond its immediate implications for maternal and fetal health, however, pregnancy may also provide valuable insights into a woman's future cardiovascular health. Growing scientific evidence suggests that certain pregnancy complications are associated with an increased risk of cardiovascular disease years after childbirth. A recent review published in The Lancet in September 2026, together with a large population-based study published in BMJ Medicine in October of the same year, highlights the importance of pregnancy history in long-term cardiovascular prevention¹^,².

During pregnancy, circulating blood volume increases, the heart pumps more blood, and the blood vessels adapt to meet the body's increased demands. These changes explain why pregnancy is often described as a natural cardiovascular “stress test”. Although most women adapt without complications, in some cases this additional physiological burden may reveal an underlying susceptibility to cardiovascular disease that would otherwise remain unrecognised for years¹.

Among the most important pregnancy complications are pre-eclampsia and gestational hypertension. Pre-eclampsia typically develops after the 20th week of pregnancy and is characterised by elevated blood pressure accompanied by evidence of organ dysfunction or other clinical abnormalities. Gestational hypertension, on the other hand, refers to high blood pressure developing during pregnancy without the additional features required for a diagnosis of pre-eclampsia. Although these conditions often resolve after childbirth, increasing evidence suggests that their implications for women's health may extend well beyond pregnancy¹^,³.

Of particular interest are the findings of a recent study published in BMJ Medicine on October 6, 2026. Researchers analysed the medical records of 1,432,795 women in England, investigating the associations between pregnancy complications and the subsequent development of cardiovascular disease, hypertension, type 2 diabetes and chronic kidney disease. The median follow-up period was approximately four years.²

According to the findings, women who experienced gestational hypertension or pre-eclampsia subsequently developed hypertension at approximately four times the rate observed in women without these complications. The rate of cardiovascular disease was also approximately 60% higher, while an increased rate of chronic kidney disease was observed. These results suggest that hypertensive disorders of pregnancy may serve as markers of increased future cardiovascular and renal risk².

Equally important is the association between gestational diabetes and future cardiometabolic health. In the same study, women with a history of gestational diabetes had approximately a seven times higher rate of subsequently developing type 2 diabetes. Associations with increased rates of hypertension and cardiovascular disease were also reported. Other adverse pregnancy outcomes, including preterm birth and pregnancy loss, were similarly associated with subsequent health risks, although the strength of these associations varied².

The relationship between pregnancy complications and cardiovascular disease may be explained, at least in part, by shared biological mechanisms. Pre-eclampsia, for example, is associated with endothelial dysfunction, a condition in which the inner lining of blood vessels does not function normally. Inflammation, insulin resistance and abnormalities in the small blood vessels may also contribute to the development of both pregnancy complications and cardiovascular disease¹.

However, it remains unclear to what extent pregnancy complications directly cause long-term cardiovascular changes or simply reveal underlying risk factors that were already present before pregnancy. This relationship is likely to involve complex interactions between genetic, metabolic and vascular mechanisms. Therefore, although the association has been consistently demonstrated in large population-based studies, it should not be interpreted as evidence of a direct causal relationship¹^,⁴.

The value of pregnancy history in cardiovascular risk prediction was also examined in a 2026 study involving more than 59,000 women from the Nurses' Health Study II. Researchers found that several adverse pregnancy outcomes were associated with increased long-term cardiovascular risk. However, incorporating this information into established cardiovascular risk prediction models resulted in only modest improvements in their predictive performance. Consequently, pregnancy history provides valuable complementary information but does not yet allow accurate prediction of cardiovascular disease at an individual level⁵.

These findings highlight the need for a more comprehensive approach to cardiovascular prevention in women. Traditionally, cardiovascular risk assessment has focused on established factors such as age, smoking, blood pressure, cholesterol and diabetes. However, pregnancy complications may provide additional information, particularly for younger women who might otherwise be considered at low short-term cardiovascular risk. The 2025 European Society of Cardiology guidelines recognise the importance of adverse pregnancy outcomes for future cardiovascular health and emphasise the need for appropriate long-term follow-up³.

In clinical practice, women with a history of pre-eclampsia, gestational hypertension or gestational diabetes should inform their healthcare professionals about these complications, even several years after childbirth.

Regular monitoring of blood pressure, blood glucose and cholesterol, combined with physical activity, a balanced diet and smoking avoidance, may help identify and manage cardiovascular risk factors at an earlier stage. At the same time, closer collaboration between obstetricians, cardiologists and primary care professionals could help ensure continuity of care after childbirth. Importantly, experiencing a pregnancy complication does not mean that a woman will inevitably develop cardiovascular disease. Rather, it may provide an opportunity for earlier and more personalised prevention.

Pregnancy should therefore be recognised not only as an important event in a woman's reproductive life, but also as a period that may offer meaningful insights into her future health. Identifying pregnancy complications as potential early markers of cardiovascular risk could support more effective preventive strategies and improve long-term healthcare for women.

A woman's pregnancy history is an integral part of her cardiovascular history. Recognising its importance may create new opportunities to protect her health throughout her life.

References

1. Pabón MA et al. Adverse pregnancy outcomes and long-term cardiovascular disease risk. Lancet. 2026;408:952–968. 

2. Wambua S et al. Pregnancy complications and risk of cardiometabolic-renal conditions in 1.4 million women in England: longitudinal study. BMJ Medicine. 2026;5:e003035.

3. De Backer J et al. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy. European Heart Journal. 2025;46:4462–4568. 

4. Parikh NI et al. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women. Circulation. 2021;143:e902–e916.

5. Liu T et al. Lifetime adverse pregnancy outcome history and cardiovascular risk. Hypertension. 2026;83:e25916.