Yes. Some pregnancy complications are linked to a higher risk of heart disease and stroke years or decades later. The best studied are preeclampsia and other high blood pressure disorders of pregnancy, gestational diabetes and preterm delivery.
The complication usually ends with delivery. The signal it sends does not. If you had one of these, it is a piece of your medical history that still matters at 45, 55 and 65, and it gives you an early reason to keep an eye on your risk factors.
Key takeaways
- Preeclampsia, gestational diabetes and preterm birth are each tied to higher cardiovascular risk later in life.
- The increase is relative, so for a healthy woman in her 30s or 40s the actual chance of an event stays low.
- US cholesterol guidance has counted a history of preeclampsia as a factor that raises risk.
- Pregnancy history does not show up in lab results, so your doctor only knows if you say so.
Which pregnancy complications count
Doctors group these under the term adverse pregnancy outcomes. An American Heart Association scientific statement lists hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption and pregnancy loss as outcomes that raise the risk of later cardiovascular disease.1
This article covers the three with the largest pooled studies behind them.
| Complication | What it is | Later risk in pooled studies |
|---|---|---|
| Preeclampsia | High blood pressure with signs of organ stress, arising in pregnancy | About 4 times the risk of heart failure, about 2 times for coronary heart disease and stroke |
| Gestational diabetes | High blood sugar first found during pregnancy | About 2 times the risk of cardiovascular events |
| Preterm delivery | Birth before 37 weeks | About 40% higher risk of cardiovascular disease |
Preeclampsia and high blood pressure in pregnancy
Preeclampsia is high blood pressure that develops during pregnancy together with signs that organs such as the kidneys or liver are under strain. Blood pressure often settles after delivery, which is why many women assume the episode is closed.
The long-term data say otherwise. A pooled analysis of 22 studies covering more than 6.4 million women found that preeclampsia was linked to about four times the risk of later heart failure and about twice the risk of coronary heart disease, stroke and cardiovascular death.2 The link held after the researchers accounted for age, body weight and diabetes.
Guidelines have taken notice. The 2018 US cholesterol guideline named a history of preeclampsia as a risk-enhancing factor, meaning it can tip a borderline decision toward closer attention.3
Gestational diabetes
Gestational diabetes is high blood sugar first detected in pregnancy. For most women, blood sugar returns to normal after the birth.
Two findings are worth knowing. In a meta-analysis of 20 studies, women with a history of gestational diabetes were almost 10 times as likely to develop type 2 diabetes as women whose blood sugar stayed normal in pregnancy.4 Diabetes is itself a major driver of heart disease.
The heart risk is not explained by diabetes alone. A separate meta-analysis of more than 5 million women found about twice the risk of later cardiovascular events after gestational diabetes. Among women who never went on to develop type 2 diabetes, the risk was still 56% higher.5 The pattern points to an underlying tendency toward insulin resistance that pregnancy brings to the surface.
Preterm delivery
Preterm delivery means giving birth before 37 weeks. It is less well known as a heart risk marker than the other two.
In a pooled analysis of 21 studies and more than 5.8 million women, preterm delivery was linked to about a 40% higher risk of later cardiovascular disease in the mother and about twice the risk of death from coronary heart disease. The highest risks appeared when the birth was before 32 weeks, or when doctors had to deliver early for medical reasons.6
Keeping the numbers in proportion
These are relative figures. Heart attacks and strokes are uncommon in women in their 30s and 40s, and twice a small risk is still a small risk. The concern is the long view: risk that starts building earlier has more years to add up.
These studies also show a link, not proof that pregnancy caused the later disease. One common explanation is that pregnancy acts like a stress test, exposing a tendency toward high blood pressure or blood sugar problems that was already there.
One more honest limit. The heart association statement says pregnancy history should be recognized when risk is evaluated, but that its value in reclassifying risk may not be established. It is a prompt to look more closely. It is not a score.
What gets checked afterward
A history of pregnancy complications changes how often the basics get looked at, not which basics they are. The usual list:
- Blood pressure, checked regularly instead of only when something feels wrong.
- Blood sugar, usually a fasting glucose or A1c, particularly after gestational diabetes.
- Cholesterol, with a standard lipid panel as the starting point.
- Weight and waist size, tracked over time.
The heart association statement describes this history as a prompt for more vigorous prevention, and points to a heart-healthy diet and regular physical activity, begun after the birth and kept up for life, as the main lifestyle measures. It also notes that breastfeeding may lower later cardiometabolic risk.1
The practical step is to tell every new doctor. A complication from 20 years ago rarely appears in a current chart, and standard blood work will not reveal it. If you also have relatives with early heart disease, read our guide to family history of early heart disease, because the two kinds of history add together.
Your next step
If you had one of these complications, start by learning how your overall risk is estimated. Our guide to the PREVENT risk calculator explains what goes into the percentage, and our guide to A1c and heart disease risk covers the blood sugar side.
You can also answer the three quick questions in the screener on the Cardio Res-Q program page to see whether a closer look makes sense for you.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
I had preeclampsia 20 years ago. Does it still matter?
Yes. The studies followed women for many years after pregnancy and the higher risk persisted, which is why a history of preeclampsia has been listed in US cholesterol guidance as a risk-enhancing factor. Mention it to your doctor even if nobody has asked.
My blood pressure went back to normal after delivery. Am I in the clear?
A normal reading after delivery is good news, but women in these studies still had higher long-term risk as a group. The authors of the preeclampsia analysis concluded that it supports lifelong monitoring of cardiovascular risk factors.
Does a complicated pregnancy mean I will get heart disease?
No. It raises the odds. It does not decide the outcome. Most of the added risk appears to work through blood pressure, blood sugar, cholesterol and weight, all of which can be measured and managed with your clinician.
Is pregnancy loss linked to later heart risk too?
The American Heart Association statement includes pregnancy loss, placental abruption and small-for-gestational-age delivery among the outcomes tied to later cardiovascular risk. If any of these are part of your history, they are worth sharing with your doctor along with the rest.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
