Women with pregnancy complications may be able to lower future cardiovascular risk

Women with a history of pregnancy complications are at higher risk for cardiovascular disease, but they can greatly lower that risk, new research suggests.

Having healthy lifestyle behaviors and managing blood pressure, cholesterol and blood glucose levels after giving birth significantly lowered their risk for future cardiovascular disease to rates on par with women who didn't have pregnancy complications, the study found. The findings, which were presented Thursday at the American Heart Association's Epidemiology, Prevention, Lifestyle and Cardiometabolic Health conference in Chicago, are considered preliminary until full results are published in a peer-reviewed journal.

"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," lead researcher Dr. Frank Qian said in a news release. Qian is a cardiovascular medicine fellow at Boston Medical Center and a clinical instructor at Boston University's 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."

According to a 2021 AHA report, many adverse pregnancy outcomes are linked to future cardiovascular disease risk factors, including high blood pressure, also known as hypertension, Type 2 diabetes and high cholesterol. In the new study, adverse pregnancy outcomes included placental abruption, gestational diabetes, small size for gestational age, preterm birth and hypertensive disorders of pregnancy, defined as preeclampsia or gestational hypertension.

Qian and his colleagues analyzed data for 2,263 women in the UK Biobank database with a history of adverse pregnancy outcomes and 107,260 women with no history of complications, all of whom were free of cardiovascular disease at the start of the study. The researchers measured each woman's cardiovascular health using eight key metrics from the AHA, referred to as Life's Essential 8. These include eating a healthy diet, staying physically active, not smoking, getting enough sleep, and managing weight, cholesterol, blood pressure and blood glucose levels. Scores ranged from 0 to 100, with higher scores indicating better cardiovascular health.

Over an average 13.5 years of follow-up, women with better cardiovascular health measures after giving birth (scores higher than 76) had a 57% lower risk of developing cardiovascular disease than women with poorer cardiovascular health measures (those who scored below 67).

Women who had complicated pregnancies and poor cardiovascular health measures after giving birth had a 148% higher risk for future cardiovascular disease than women with better heart health measures who did not have pregnancy complications. Even if they had no history of pregnancy complications, women with low and intermediate cardiovascular health scores were at 81% and 25% higher risk, respectively, for future cardiovascular disease.

But maintaining good heart health measures after giving birth was so beneficial, it leveled the field for women who had adverse pregnancy outcomes. Those who achieved high cardiovascular health scores after pregnancy were at similar risk for cardiovascular disease as those with good heart health measures and no history of pregnancy complications.

"These findings are important for clinical practice as well as designing public health interventions and policies," Qian said. "We need to identify high-risk women and focus on ensuring they have access to lifestyle (changes) or treatment to reduce their long-term risk of cardiovascular disease."

The findings are important because they suggest a group of women considered at high risk for cardiovascular issues can potentially prevent them, said cardiologist Dr. Nieca Goldberg, a clinical associate professor of medicine at NYU Grossman School of Medicine, in the news release. Goldberg was not involved in the new study.

"We need to encourage health care professionals to integrate Life's Essential 8 into clinical practice to improve heart health in women with and without pregnancy-related disorders," she said. Because 94% of the women in the study were white, Goldberg pointed out the need to explore whether the findings would hold true for women from other races and ethnicities.