What Pregnancy Can Tell You About Your Heart Health

Pregnancy places extraordinary demands on the heart. Blood volume surges, the heart pumps harder and the body must rapidly adapt to support sweeping physiological changes. In that sense, pregnancy is more than a life-changing event—it’s often a woman’s first free physiological stress test.

“Women who experience complications during pregnancy, such as high blood pressure, preeclampsia, preterm delivery and gestational diabetes, carry a two- to eight-fold higher risk of developing heart disease by the time they turn 60,” said Margo Minissian, PhD, executive director of the Geri and Richard Brawerman Nursing Institute at Cedars-Sinai and the Simms/Mann Family Foundation Chair in Nurse Education, Innovation and Research. “For these women, pregnancy can unmask an existing predisposition to heart disease before traditional risk factors become clinically relevant. It's as if you're looking into a crystal ball for cardiovascular risk.”

Women, Pregnancy and Heart Disease

Cardiovascular disease remains the leading cause of death among women in the U.S. It kills more women each year than all cancers combined. And yet, many women still think of heart disease as something that typically happens to men, and usually later in life.

The typical image of heart disease is a man clutching his chest in pain.

Women who experience complications during pregnancy, such as high blood pressure, preeclampsia and gestational diabetes, carry a two- to eight-fold higher risk of developing heart disease by the time they turn 60.

“But when women have heart disease, they often experience more subtle signs, such as shortness of breath, nausea, jaw pain or mild chest pressure,” said C. Noel Bairey Merz, MD, director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai and the Irwin and Sheila Allen Chair in Women’s Heart Research.

Women are also more likely to develop forms of heart disease that aren’t easy to detect. Instead of a blocked artery, women may develop problems in the heart’s smaller blood vessels, a condition known as coronary microvascular dysfunction. Women are also more likely to develop a form of heart failure in which the heart still pumps but becomes stiff over time.  

“Unfortunately, because women’s symptoms may look different from men’s, they are too often dismissed,” Minissian said. “But it’s important to remember that women are not atypical. We’re not an anomaly. We’re half the population, and pregnancy history can provide important clues about heart disease risk decades before symptoms set in.”

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Which Pregnancy Complications Are Linked to Later Heart Problems?

Pregnancy may provide the earliest evidence of how a woman’s cardiovascular system responds to stress. It’s the only time when a woman’s body goes through an inflammatory process that is part of normal physiology rather than disease.

“Pregnancy gives us valuable insight into a woman’s vascular health since the blood vessels have to open up to accommodate the increased blood flow of pregnancy and then constrict back to normal after delivery,” Minissian said.

The following complications do not guarantee future heart disease, but they do require closer monitoring: ‍

• ‍Gestational diabetes: Women who develop higher than normal blood glucose levels during pregnancy, called gestational diabetes, are at increased risk of developing Type 2 diabetes and heart disease.
• ‍High blood pressure: Also called gestational hypertension, high blood pressure during pregnancy happens when blood pressure rises to 140/90 mmHg or higher after 20 weeks of pregnancy in a woman with previously normal readings of 120/80 mmHg or lower. These women have a significantly higher risk of developing future heart disease and stroke.
• ‍Hyperemesis gravidarum: This severe form of nausea and vomiting during pregnancy can lead to dehydration, weight loss and electrolyte imbalance. Emerging research links hyperemesis gravidarum with increased heart disease risk later in life, including heart failure, cardiomyopathy, valve disease and heart rhythm disorders.‍
• Preeclampsia: In addition to high blood pressure, women with preeclampsia show signs of damage to their liver, kidneys and other organs. Preeclampsia doubles the risk of developing heart disease or stroke later in life. It’s also associated with chronic hypertension. “A decade after preeclampsia, young, asymptomatic women already show small vessel dysfunction,” said Bairey Merz. “These are women in their 40s, running around taking care of kids, who don’t know they’re at risk.”

Other complications during pregnancy, including pregnancy loss, preterm delivery and placental abruption, may also point to a higher chance of heart problems later in life. Women with three or more pregnancy losses are twice as likely to develop heart disease, and preterm delivery roughly doubles that risk.

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Heart Health in the “Fourth Trimester”

The six-week postpartum visit often closes the door on regular health check-ins, but from a cardiovascular perspective, Minissian suggests it should be opening one.

“If you developed complications during pregnancy, that doesn’t mean you’re destined for a heart attack,” said Minissian. “But it is an opportunity for you and your healthcare provider to identify and manage the heart disease risk factors that are within your control. That means continuing to monitor blood pressure, blood glucose, cholesterol and other heart health markers.”

The good news: Studies show women who had pregnancy complications and achieved and maintained good heart health after delivery had a similar risk of heart disease as women with no pregnancy or heart concerns. That’s why pregnancy history must follow women into primary care, cardiology and future gynecology visits.

Proactive Steps to Protect Your Heart After a Complicated Pregnancy

While you can’t change your history of pregnancy loss or preeclampsia, you can use that history as an early warning sign, and act on it.

“When we do a better job managing traditional cardiovascular risk factors, we can often prevent women from having subsequent adverse pregnancy outcomes,” said Minissian.

Fortunately, there are plenty of things you can do to support your heart health, including:  

• Eat a healthy diet.
• Exercise regularly.
• Get at least seven hours of sleep.
• Don’t smoke.
• Maintain a healthy weight.
• Manage blood sugar, blood pressure and cholesterol.
• Schedule regular visits with your physician.

If you develop complications during pregnancy, the most important thing you can do is include that history in your discussions with healthcare providers moving forward.

“Pregnancy is not just a temporary condition for nine months. It’s a predictor of heart health for the rest of your life,” said Bairey Merz. “When we treat these conditions early, and continue monitoring through midlife and beyond, we can prevent catastrophic outcomes.”

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