Can Pregnancy Complications Affect Your Heart Health Later in Life?

Carrying extra weight, having high blood pressure and being sedentary are well-known risk factors for cardiovascular disease (CVD). But another major risk factor may surprise you: pregnancy complications.

Studies have shown that moms who’ve experienced certain types of complications are at risk for CVD even years after their babies have left the nest and started families of their own.

Cardiologists with Baptist Health say that pregnancy places significant demands on the cardiovascular system. It leads to many vascular, metabolic and physiological adaptations in the mother—including increased blood volume, cardiac output and metabolic stress—that support the growth and development of the fetus.

Pregnancy a Stress Test for the Body

Rachel Schoss Eidelman, M.D., a cardiologist with Baptist Health Heart & Vascular Care, points to research showing that certain complications during pregnancy are not just isolated obstetric events. Instead, they can be early markers of CVD.

“Think of pregnancy as an early cardiovascular ‘stress test’ for the body,” says Dr. Eidelman. “For some women, the intense physiological changes required to support a growing baby can expose a predisposition to heart and vascular conditions.”

When the body struggles to adapt to these demands, adverse pregnancy outcomes (APOs) can occur, Dr. Eidelman says. These complications are now recognized by major cardiovascular organizations as sex-specific risk factors for heart disease. They offer a unique opportunity to identify women at risk much earlier than traditional screening models might allow—especially in younger women who might otherwise be considered low risk.

“Think of pregnancy as an early cardiovascular ‘stress test’ for the body. For some women, the intense physiological changes required to support a growing baby can expose a predisposition to heart and vascular conditions.”

Rachel Schoss Eidelman, M.D., cardiologist, Baptist Health Heart & Vascular Care

According to a scientific statement from the American Heart Association (AHA), pregnancy can lead to “many vascular, metabolic, and physiological adaptations in the mother, including increased insulin resistance, adipose deposition, hypercoagulability, cardiac remodeling and decreased vascular resistance.”

The AHA report goes on to state that 10 to 15 percent of all pregnancies are affected by one or more of these complications. These issues can reveal a woman's vulnerability to vascular or metabolic problems years or even decades before heart disease becomes apparent.

Complications Linked to Later Heart Disease

The AHA has identified six major pregnancy-related complications that significantly increase a woman’s risk for developing cardiovascular disease later in life.

The statistics on this increased risk are startling:

• High blood pressure during pregnancy, known as gestational hypertension, increases a woman’s risk of cardiovascular disease later in life by 67 percent and increases the odds of a stroke by 83 percent.
• Preeclampsia, a more severe form of high blood pressure in pregnancy, is associated with nearly three times the risk of developing cardiovascular disease in later life.
• Gestational diabetes, the onset of Type 2 diabetes during pregnancy, is associated with a 68 percent higher risk of heart disease. This risk remains even if blood sugar levels return to normal after delivery.
• Preterm delivery, defined as childbirth before 37 weeks of gestation, has been found to double the risk of developing cardiovascular disease and is also strongly associated with future stroke.
• Placental abruption, which is the separation of the placenta from the uterus before childbirth, is associated with an 82 percent increased risk for heart disease.
• Stillbirth, or pregnancy loss after 20 weeks, is associated with a nearly two-fold risk for cardiovascular problems later in life.

Recognizing these factors early allows for earlier intervention, says Andrea Vitello, M.D., a cardiologist with Baptist Health Miami Cardiac & Vascular Institute. “One of my goals is to help identify a younger patient population that might not otherwise be aware of their cardiovascular risk,” she says.

Understanding the Connection

Dr. Vitello says that researchers are still working to understand the precise mechanisms that link these pregnancy complications to future heart disease. She says it’s uncertain whether the complications actually cause cardiovascular disease or if they simply surface a preexisting risk.

“Many women who experience complications are never informed that these events increase their future heart risk. As a result, crucial monitoring often stops once the postpartum period ends.”

Andrea Vitello, M.D., cardiologist, Baptist Health Miami Cardiac & Vascular Institute

Several overlapping theories are being explored, according to Dr. Vitello:

• Endothelial Dysfunction: The pregnancy complication may cause lasting damage to the lining of blood vessels.
• Persistent Inflammation: The inflammatory processes involved in conditions like preeclampsia may not fully resolve after delivery.
• Metabolic Changes: Gestational diabetes can lead to lasting changes in how the body processes sugar and fats.
• Structural Heart Changes: Hypertensive disorders of pregnancy can cause changes to the structure of the heart itself.

Regardless of the exact cause, these complications function as critical early warning signs, says Dr. Vitello. Women with a history of these complications should be screened more closely for cardiovascular risk factors like high blood pressure, high cholesterol and Type 2 diabetes. This knowledge can empower women and their healthcare providers to take proactive steps toward prevention, she says.

Gaps in Awareness and Follow-Up Care

Despite the growing body of evidence, a woman’s pregnancy history is often overlooked during routine cardiovascular risk assessments, Dr. Vitello says. “Many women who experience complications are never informed that these events increase their future heart risk. As a result, crucial monitoring often stops once the postpartum period ends.”

The AHA scientific statement calls for vigorous efforts to prevent cardiovascular disease among women who experience these complications. It emphasizes the need for a smooth transition from postpartum care back to primary care, with continued follow-up to monitor their risk throughout their lives.

“We need to better understand how pregnancy affects the cardiovascular system at various stages,” Dr. Vitello says. “There is a real need for a collaborative approach in monitoring and caring for this high-risk population.”

What Women Should Do

Many healthcare providers may not ask about past pregnancies, so Dr. Eidelman advises informing your primary care physician if during pregnancy you experienced complications such as high blood pressure, preeclampsia, gestational diabetes, preterm delivery, placental abruption or pregnancy loss.

The impact on your health may not be seen for 10 years or more after your pregnancy, which is all the more reason to be proactive now, says Dr. Eidelman, emphasizing the importance of early screening and prevention for all women. “You have to screen for blood pressure and metabolic disorders, and make sure you get your lipid profiles done.”

Adopting a heart-healthy lifestyle is even more critical, she adds. “That includes eating a balanced diet, maintaining a healthy weight, getting regular exercise and not smoking.” By taking these steps and working with your physician to monitor your heart health, you can actively reduce your risk and work toward a healthier future, Dr. Eidelman assures.

One way to understand your personal risk of developing heart disease is to get a heart scan. In just 30 minutes, a non-invasive CT scan can uncover risks you didn’t even know existed. Talk to your doctor and see if a heart scan is right for you. Visit BaptistHealth.net/HeartScan or call 833-596-2473 to find out more.