Complications during pregnancy (or adverse pregnancy outcomes), like gestational diabetes and newly developed high blood pressure, act as nature's stress test and may uncover an individual's risk for heart disease later in life, according to new research published in the JACC, the flagship journal of the American College of Cardiology. The study also highlights how weight management before pregnancy may not only improve maternal health but also reduce future cardiovascular disease risk.
The observational study, which tracked outcomes for women over more than 10 years, helps answer a key question: whether pregnancy complications contribute to cardiovascular risk, or are just a marker for underlying risk factors that were there all along.
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."
Jaclyn Borrowman, PhD, researcher at Northwestern University and lead author of the study
Pregnancy is often considered a "window" into future health, as complications during pregnancy can reveal underlying risks for chronic conditions, Borrowman noted. Adverse pregnancy outcomes affect around 20% of all pregnancies in the United States and are known to increase risk of later cardiovascular disease by two to four times.
For the study, researchers tracked 4,269 pregnant women across nine countries, following up on outcomes over 10 to 14 years. They looked at measurements for blood pressure, triglycerides, fasting glucose, and hemoglobin A1c, comparing participants with overweight or obesity with those who had normal BMI. Secondary outcomes included incidence of hypertension or diabetes at the midlife follow-up.
They found that adverse pregnancy outcomes contributed significantly to the link between pre-pregnancy overweight or obesity and cardiovascular risk factors in midlife. In addition, different types of complications affect different health risks. Specifically, gestational diabetes enhanced risk for higher glucose and hemoglobin A1c, while hypertensive disorders contributed to risk for high blood pressure in midlife.
Borrowman noted that, even though these pregnancy complications helped explain the link between pre-pregnancy weight and heart disease risk, they didn't account for most of the connection-other factors are also involved.
"The study highlights the significance of adverse pregnancy outcomes as a risk-enhancing factor for cardiovascular disease," Borrowman said. "Our results also suggest that prioritizing weight management among those considering pregnancy may promote both maternal and future cardiovascular health."
In an accompanying editorial comment, Garima Sharma, MD, Director of Preventive Cardiology and Women's Cardiovascular Health at Inova Health System, said the study provides "insightful information" that could help guide screening, counseling and management.
"The results of the study underscore the value in addressing excess adiposity in the pre-pregnancy and postpartum period, particularly as there are options with emerging therapies such new anti-obesity medications" she said.
Sharma added that the findings also highlight the need to study the safety and efficacy of these medications in pregnant and lactating women, who have historically been excluded from clinical trials.
As a follow-up, Borrowman said researchers are studying the link between early pregnancy cardiovascular health and the incidence of complications, with the goal of identifying potential interventions that could improve maternal health and reduce cardiovascular disease.
The paper, "Pre-Pregnancy Adiposity, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk in Midlife," and the editorial comment, "Maternal Obesity and Adverse Pregnancy Outcomes as Mediators of Cardiovascular Disease Risk in Midlife," were published April 14, 2025, in JACC.
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