Women who experience adverse pregnancy outcomes exhibit persistently higher cardiovascular disease risk factors from a decade before pregnancy through at least 15 years postpartum, according to a new UK cohort study.
Published in BMC Medicine, the study, led by Kate Birnie et al., analyzed electronic health records from 187,186 women with registered pregnancies in the UK Clinical Practice Research Datalink (CPRD) GOLD, documenting 311,156 pregnancies. Researchers tracked changes in body mass index (BMI), blood pressure (BP), cholesterol, and glucose levels over time. Women with gestational hypertension, preeclampsia (PE), or gestational diabetes had higher BMI, systolic and diastolic BP, and glucose levels up to 10 years before pregnancy, with these differences persisting long after childbirth. Notably, women with gestational diabetes demonstrated a steeper post-partum rise in glucose compared to women without this condition.
Women with multiple miscarriages, stillbirths, or medically indicated preterm births also had elevated BP and BMI before and after pregnancy. The study found distinct patterns between types of preterm births: women with medically indicated preterm births had higher BP, BMI, and glucose before and after pregnancy compared to women with spontaneous preterm births or full-term deliveries.
Those with multiple adverse pregnancy outcomes (APOs) had the most unfavorable cardiometabolic profiles, with each additional APO correlating with worsening risk factors in a dose-response relationship. For example, ten years after first pregnancy, predicted systolic BP was 119.5 mmHg for women with no APOs, increasing to 121.2 mmHg, 124.3 mmHg, and 127.1 mmHg for women who experienced 1, 2, and 3+ APOs, respectively. Differences in total cholesterol between women with and without APOs diminished about 10 years after pregnancy despite medication use.
"Women who experienced APOs had adverse cardiometabolic health profiles prior to first pregnancy, and differences persisted up to 15 years post-pregnancy," said lead author Kate Birnie from University of Bristol, Bristol, UK.
The study leveraged CPRD GOLD data linked to Hospital Episode Statistics, covering pregnancies from 1997 to 2019. Researchers used fractional polynomial multilevel models to assess cardiometabolic risk factor trajectories relative to first pregnancy and age, adjusting for confounders such as socioeconomic status, smoking, ethnicity, and medication use. Systolic and diastolic BP were the most frequently recorded risk factors, available for 94% of participants, followed by BMI (87%), glucose (47%), and cholesterol (22%). The study population was predominantly White (86.5%), with a mean age of 27.1 years at first pregnancy.
These findings suggest APOs may serve as early indicators of future cardiovascular disease (CVD) risk, highlighting the need for long-term monitoring and preventive care. The researchers noted that some pregnancy complications, such as PE, may be "cardiovascular complications of pregnancy" rather than isolated obstetric conditions. Pregnancy could potentially "unmask" an underlying predisposition to CVD.
This study benefits from a large sample size and extensive longitudinal data, allowing for robust analysis of cardiometabolic trajectories. However, potential selection bias remains a limitation, as women with recorded cardiometabolic risk factors may differ from those without available data. Additionally, undocumented miscarriages or congenital anomalies in terminated pregnancies could not be accounted for.
The findings reinforce the need for targeted public health interventions and routine CVD risk monitoring in women with adverse obstetric histories. "APOs may identify young women who could benefit from monitoring of CVD risk factors and interventions to improve cardiometabolic health in the postpartum years," the authors concluded.
This research was funded by the British Heart Foundation. The authors reported no competing interests.
