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High blood pressure during pregnancy can warn of heart disease risk years later

More evidence suggests pregnancy is a kind of stress test for the heart, revealing a woman’s pre-existing predisposition for a heart attack or stroke years after giving birth.

Women who developed high blood pressure while pregnant had a 63% increased risk for developing cardiovascular disease later in life, researchers reported this month in the Journal of the American College of Cardiology.

“This is a risk that arises over the years and persists for decades after delivery,” Jennifer Stuart, the study’s first author and an associate epidemiologist in the division of women’s health at Brigham and Women’s Hospital in Boston, told TODAY.

“I try to take the posture of empowering women and trying to find ways to use this to reduce risk because unfortunately once you have it — much like having a family history of cardiovascular disease — you can’t get rid of it.”

’Failed’ stress test

The risk emerged about 10 years after the first birth for women who had preeclampsia — high blood pressure and protein in the urine during pregnancy, the study found. These patients were more likely to have a coronary artery event, such as a heart attack, compared to women who had a normal blood pressure while pregnant.

For women who had gestational hypertension — a spike in blood pressure during pregnancy, but without kidney problems — the risk appeared 30 years after the first birth. These patients were more likely to have a stroke.

While it’s not fully known if the higher risk is due to some sort of damage that happens during that complication in pregnancy, most researchers believe it’s simply unmasking a health problem that’s already there, Stuart said. “Essentially, a ‘failed’ stress test is having some of these complications,” she added.

The risks persisted even when the researchers adjusted for risk factors such as having a family history of heart disease or having a BMI that fell into the overweight or obese category before pregnancy, which was surprising, Stuart said.

Four factors account for majority of the risk

The findings were based on data from more than 60,000 women in the Nurses’ Health Study II who were followed for almost 30 years. Researchers analyzed their pregnancy history, cardiovascular health history, BMI and other health records.

About 10% of the participants had gestational hypertension and preeclampsia in their first pregnancy.

Researchers found 64% of the increased cardiovascular risk linked with these conditions later in life could be explained by “four simple things that we know how to measure and target,” Stuart said: developing chronic high blood pressure after giving birth, high cholesterol, diabetes and gaining weight.

“This study reinforces how important it is for women and their healthcare providers to address known cardiovascular disease risk factors, such as obesity or having high blood pressure, while thinking about starting a family and then during and after during pregnancy,” said Victoria Pemberton, a researcher at the National Heart, Lung and Blood Institute, in a statement. NHLBI funded the research.

Doctors need to ask women about their history of pregnancy complications such as gestational hypertension or preeclampsia, and patients who’ve experienced those complications should be informed that they have an increased risk for heart disease, Stuart said.

She was concerned this information often "gets stuck or siloed" at the obstetrician’s office and doesn’t get transferred to a woman’s primary care provider.

“This subgroup of women… might be under the radar of preventive cardiologists, internists and family practitioners,” doctors wrote in an accompanying editorial comment for the study. There’s a need for extended follow-up beyond the 12-week postpartum period for women with pregnancy complications, known as the “fourth trimester,” they added.

It’s also important for women to adopt healthy habits, such as regular exercise and a heart-healthy diet, earlier in life — before developing these risk factors, Stuart said.

“(We want) women to feel empowered to use this information to improve their health rather than be overwhelmed or daunted by an increased risk after what can be a really complicated pregnancy,” she noted.

Source: Today Show