A new study in the Journal of the American Heart Association shows an increased risk of cardiovascular problems in middle age for women who had pre-eclampsia, pregnancy-related diabetes or extra small newborns.
"Ask your doctor about your cardiovascular risk if you had pregnancy complications."
The study, led by Abigail Fraser, MPH, Ph.D., at the School of Social and Community Medicine at the University of Bristol in England, looked at 3,416 pregnant women who pewee part of the Avon Longitudinal Study of Parents and Children in the early 1990s.
The researchers looked at the cases of women with complications including gestational diabetes, pre-eclampsia, early delivery and babies born in the upper and lower percentiles for weight.
Pre-eclampsia is a complication where a woman's blood pressure is too high and protein leaks into her blood from the amniotic fluid. The only way to treat it is to have the baby, often delivered early.
Almost a third of the study group - 1,002 women - had one pregnancy complication; 175 had two complications, and 26 had three.
The researchers then looked at the cardiovascular risk factors of all the women in the study 18 years later. The average age of the women in the second half of the study was 48 years old.
Fraser's group used the cardiovascular Framingham risk score to determine the women's likelihood of having a serious cardiovascular problem. This score takes into account age, total and HDL cholesterol, systolic blood pressure, and whether a woman has diabetes or smokes.
Women who had pre-eclampsia, gestational diabetes or an underweight baby had a greater risk of heart disease, though the factors associated with each of these pregnancy conditions was different.
Pre-eclampsia had the greatest association with future cardiovascular problems: women with pre-eclampsia were 31 percent more likely to develop heart disease later.
The cardiovascular risk factors correlated with pre-eclampsia included having a higher body mass index, a larger waistline and higher blood pressure, lipids and insulin.
Pregnancy-associated, or gestational, diabetes wasn't far behind pre-eclampsia, with a 26 percent greater risk of having heart disease later in middle age. These women's risk factors were higher levels of fasting glucose and insulin.
Because the women in the study were evaluated only for their heart disease risk and had not actually had a cardiovascular event yet, the researchers could not determine whether pre-eclampsia or gestational diabetes had separate or compounded effects on cardiovascular health and risk.
"Pregnancy may provide an opportunity to identify women at increased risk of heart disease while they are relatively young," Fraser said.
"Thus, it would be useful for medical professionals to have information on pregnancy complications so they can recommend lifestyle changes and any necessary medical intervention sooner," she said.
"A woman who experiences complications during pregnancy should be proactive and ask her doctor about future CVD risk and steps she should take to modify her risk," she said.
One limitation of the study was that the majority of the participants were white, so future studies could offer insights into other ethnic and racial populations regarding the connection between heart disease and pregnancy complications.
The article was published online February 17 in Circulation: Journal of the American Heart Association.
The study was funded by grants from the British Heart Foundation, Wellcome Trust and the U.S. National Institutes of Health. The authors declared no conflicts of interest.