Pregnancy Complications Can Lead to Controllable Heart Risks

Pregnancy complications put women at significantly higher risk of developing heart disease, but this risk can be reduced, according to research presented at the American Heart Association’s Epidemiology and Prevention Lifestyle and Cardiometabolic Scientific Sessions in Chicago this week. 

“Previous studies have shown that women with a history of adverse pregnancy outcomes tend to have a higher risk of developing cardiovascular disease later in life,” said lead study author Frank Qian, MD, MPH, of the Boston University Chobanian & Avedisian School of Medicine. “However, it is unknown how much of this increased cardiovascular disease risk can be potentially modified by healthy lifestyle behaviors.”

Adverse pregnancy outcomes in this study included placental abruption, gestational diabetes, small size for gestational age, preterm birth and/or hypertensive disorders of pregnancy, defined as preeclampsia or gestational hypertension. Additionally, according to the Association’s 2021 statement on Adverse Pregnancy Outcomes and Cardiovascular Disease Risk, many adverse pregnancy outcomes are associated with the future development of CVD risk factors, including hypertension, Type 2 diabetes, and dyslipidemia.

These researchers reviewed data from the UK Biobank to evaluate the association between Life’s Essential 8 scores and the development of cardiovascular disease in women with and without a history of adverse pregnancy outcomes. Life’s Essential 8 are key measures defined by the American Heart Association for improving and maintaining optimal cardiovascular health, including healthy diet, physical activity, smoking cessation, healthy sleep habits and managing weight, cholesterol, blood sugar and blood pressure. Cardiovascular health scores range from 0-100, with higher scores indicating better cardiovascular health.

The analysis found significant interactions linking adverse pregnancy outcomes, cardiovascular health scores, and cardiovascular events during the 13.5-year follow-up period, including;

• Women with better cardiovascular health measures after pregnancy had a 57% lower risk of developing cardiovascular disease.
• Women who had complications during pregnancy and poor cardiovascular health scores after pregnancy had a 148% increase in the risk of developing cardiovascular disease.
• Women with intermediate and low Life’s Essential 8 scores had an elevated risk for heart disease—25% and 81%, respectively—whether or not they had a prior history of adverse pregnancy outcomes. 

“We were most surprised to find that women who had a history of pregnancy complications and were able to achieve and maintain a high level of cardiovascular health after pregnancy significantly reduced their risk of future cardiovascular disease. They essentially had an equivalent CVD risk to women without a history of adverse pregnancy outcomes who also had high cardiovascular health,” Qian said.

He added, “We need to identify high-risk women and focus on ensuring they have access to means of improving their lifestyle or treatment to reduce their long-term risk of cardiovascular disease.”

“Our study did not include enough women from other diverse races or ethnicities to have to be able to understand how cardiovascular health metrics after an adverse pregnancy outcome may influence long-term CVD risk,” Qian said.

 “That being said, we observed a trend towards lower risk for cardiovascular disease in women who maintained better cardiovascular health after pregnancy, so these improvements in cardiovascular health should also be beneficial to women of other races and ethnicities, though more research is needed to confirm this hypothesis.”