Pregnancy complications can be an early warning sign for future cardiovascular conditions

 

Pregnancy may last only nine months, but its significance for a woman’s health can extend far beyond childbirth. Complications that develop during pregnancy may offer an early glimpse of cardiovascular risks that may surface years later.

Conditions such as gestational hypertension, pre-eclampsia and gestational diabetes are therefore increasingly being viewed as important markers of future health, not just pregnancy-related problems. A 2026 study published in the American Journal of Obstetrics and Gynaecology MFM illustrates how soon cardiovascular risk factors can emerge. Women who had experienced a pregnancy complication were about three times more likely to develop chronic high blood pressure, diabetes or high cholesterol. Among those who developed these conditions, it typically appeared within about two years after delivery.

Why can a pregnancy complication predict future heart health?

Pregnancy places unusual demands on several systems that are also important to cardiovascular health. Blood volume rises, the heart pumps more blood, and the body must continuously adjust how it regulates blood pressure, blood sugar and blood flow.

“Pregnancy represents a unique cardiovascular stress test for the mother,” says Dr Mohanty Sweta Harish, consultant paediatric cardiologist at Narayana Health City, Bengaluru.

For most women, the body adapts to these changes. But complications such as pre-eclampsia or gestational diabetes may indicate that some systems struggle to cope with the additional strain. Pre-eclampsia, for instance, offers an insight into how problems during pregnancy can affect the blood vessels.

What pre-eclampsia does to the blood vessels

Early in a healthy pregnancy, the blood vessels supplying the placenta undergo important changes that allow substantially more blood to reach it. In pre-eclampsia, this remodelling is incomplete. The placenta receives less blood than it needs and becomes stressed.

A stressed placenta releases higher levels of a protein called sFlt-1 into the mother’s bloodstream. This protein interferes with signals that normally help keep the lining of blood vessels healthy. As a result, the vessels become less able to relax, resistance to blood flow increases and blood pressure rises.

The effects are not limited to blood pressure. Because blood vessels run throughout the body, kidney function can also be affected. In severe cases, the liver and other organs may also be injured. This is why pre-eclampsia is not simply high blood pressure during pregnancy, but a condition that can affect multiple organs.

These changes often begin to ease once the pregnancy ends. Delivery usually brings improvement because the placenta, the source of excess sFlt-1, is removed. Yet studies have found that some women with a history of pre-eclampsia continue to show cardiovascular differences years later. Their blood vessels may not widen as effectively as expected, and the heart may have greater difficulty relaxing and filling with blood between beats.

Gestational diabetes: a stress test for metabolism

Pregnancy can also expose vulnerabilities in the body’s metabolism. As pregnancy progresses, hormones produced by the placenta make the mother’s body less responsive to insulin. This is a normal adaptation. To compensate, the pancreas produces more insulin to keep blood sugar under control.

In some women, however, the pancreas cannot produce enough extra insulin to meet the increased demand. Blood sugar levels rise, leading to gestational diabetes. Blood sugar often returns to normal after delivery as the metabolic demands of pregnancy recede. But developing gestational diabetes may indicate that the body struggled when its insulin-producing capacity was placed under greater demand. That vulnerability can become important later in life. Women with a history of gestational diabetes have a higher risk of developing type 2 diabetes, which is itself a major risk factor for cardiovascular conditions.

Does pregnancy cause the risk or reveal it?

Together, pregnancy complications point to several possible pathways to future cardiovascular conditions. Some women may already have an underlying vascular or metabolic susceptibility that pregnancy brings to light. Others may go on to develop chronic high blood pressure, diabetes or high cholesterol, all established risk factors for cardiovascular conditions. In women with pre-eclampsia, some changes in blood-vessel and heart function may also persist after pregnancy.

However, an important question remains: how much of the later cardiovascular risk reflects an underlying susceptibility, and how much is contributed by the pregnancy complication itself?

A 2025 Swedish study tried to tease apart these possibilities by comparing sisters. Within families where one sister had experienced an adverse pregnancy outcome and another had not, cardiovascular risk later in life was elevated even among sisters who themselves had not experienced the complication. However, the risk was higher still among the women who had experienced it.

The pattern suggests that part of the association may reflect factors sisters share, such as genetics or family environment. But these shared factors did not appear to explain the entire difference.

The study cannot establish that a pregnancy complication itself causes additional cardiovascular risk. Instead, the findings support the idea that pregnancy complications may reveal an underlying susceptibility, while leaving open the possibility that the complications could also contribute to future risk.

Why do the years after pregnancy matter?

For doctors, that distinction does not have to be completely resolved before the information becomes useful. A history of a complicated pregnancy can help identify women who may benefit from cardiovascular risk assessment earlier in life rather than waiting until problems emerge in middle age.

“We should not wait until a woman reaches middle age before addressing her cardiovascular risk,” says Dr Sarita Rao, senior interventional cardiologist and director of the Cath Lab at Apollo Hospitals, Indore.

Follow-up may include monitoring blood pressure, weight, blood sugar and cholesterol, where appropriate. Just as importantly, a history of pregnancy complications should remain part of a woman’s medical record.

The missed window after delivery

The years following pregnancy offer an important opportunity for prevention. Yet this is also a period when a woman’s regular contact with doctors looking after her own health may gradually fall away. At the same time, she may continue making regular visits to healthcare facilities for her child’s check-ups and vaccinations.

Dr Sanjiv Lewin, a paediatrician at St John’s Medical College, sees an opportunity in these visits. He says paediatric training does not adequately prepare doctors to consider the mother’s health during such encounters. “It is definitely a missed window, and the gap can easily be plugged,” he says.

Lewin suggests better coordination among obstetricians, paediatricians and other healthcare professionals so that women who have experienced pregnancy complications do not disappear from follow-up once obstetric care ends. Dr Sarita Rao similarly stresses the importance of continuity through primary-care doctors and, where necessary, cardiologists.“The goal is not to label every woman as a patient,” says Dr Sarita Rao, “but to identify those who need earlier prevention.”

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