Many people think of pregnancy complications as temporary problems that end after delivery. However, cardiology and maternal-fetal medicine experts increasingly view complications like preeclampsia as important clues about a woman’s future cardiovascular risk.
Top things to know about preeclampsia
- Preeclampsia can affect more than your pregnancy. It may be an early signal of future heart health risks — even years later.
- It doesn’t mean heart disease is guaranteed. But it does give you and your doctor important information to help prevent problems down the road.
- Your care shouldn’t stop after delivery. Blood pressure checks and a heart health screening within a few months postpartum are key steps in protecting your health.
- Small lifestyle changes can make a big difference. Staying active, eating well, managing stress and getting good sleep can help lower your risk.
- Tell your doctor about your pregnancy history. Conditions like preeclampsia, gestational diabetes or preterm birth should be part of your long-term health record.
What is preeclampsia?
During pregnancy, the body undergoes changes in hormones, heart rate, thyroid function, blood vessels, clotting and blood sugar. Sometimes, this can lead to preeclampsia — high blood pressure that develops after 20 weeks of pregnancy. Preeclampsia can continue into the postpartum period, up to six weeks after delivery.
“Pregnancy is a beautiful thing, but it’s also many women’s first natural cardiovascular stress test,” says Diane Holmes, FNP-BC, a family nurse practitioner at Atrium Health Sanger Heart & Vascular Institute’s Fourth Trimester Clinic.
Preeclampsia involves an inflammatory process in the placenta that can raise blood pressure and affect blood vessels. In more severe cases, it can affect the liver, kidneys and clotting factors.
“Prompt diagnosis is crucial, as delays can increase the risk of serious complications for both mother and baby,” says Dr. Advaita Punjala-Patel, a maternal-fetal medicine physician at Atrium Health Women's Care Maternal Fetal Medicine. “For the mother, these complications may include seizures, stroke and, in rare cases, maternal death. For the baby, the risks include preterm birth, growth restriction and even fetal death.”
Potential signs of preeclampsia include:
- Sudden high blood pressure
- Vision changes, such as auras or spots
- Nausea or vomiting
- Persistent headaches
- Pain in the upper right abdomen (where the liver is located)
Who is at risk of developing preeclampsia during pregnancy?
“A history of preeclampsia is the strongest risk factor for developing the condition in future pregnancies,” says Punjala-Patel. “Other risk factors include carrying multiples (such as twins or triplets), preexisting hypertension or diabetes, autoimmune disorders (like lupus), advanced maternal age, chronic kidney disease, first-time pregnancy and obesity.”
During pregnancy, the most effective preventive measure for those with any of these risk factors is starting a low-dose aspirin (81 mg), she says.
“This approach has proven to be the best method currently available to help reduce the risk of preeclampsia,” says Punjala-Patel. “Many women with increased risk also work closely with a maternal-fetal medicine specialist or a high-risk pregnancy doctor to better understand their individual risks and to feel confident advocating for themselves if something feels abnormal during their pregnancy.”
How preeclampsia may affect future cardiovascular risk
If you had preeclampsia during pregnancy or postpartum, that doesn’t mean heart disease is inevitable. But it does mean you and your medical team should pay attention to your heart health and take steps to prevent future cardiovascular concerns.
Potential long-term risks associated with preeclampsia include:
- Chronic hypertension (high blood pressure)
- Coronary artery disease
- Heart attack
- Heart failure
- Stroke
- Kidney disease
Some women may later develop microvascular dysfunction, where smaller blood vessels constrict or narrow, leading to chest discomfort or heart failure symptoms.
Why your provider should ask about your pregnancy history
A cardiovascular risk assessment should include your reproductive history. Pregnancy complications that may matter to your heart health include:
- Preeclampsia
- Gestational diabetes
- Multiple miscarriages
- Preterm delivery
- Placental abruption
Other female-specific heart health risk factors include:
- Autoimmune disorders (they’re more common in women than in men)
- Polycystic ovary syndrome (PCOS)
- Early menopause
Traditional risk factors that can negatively impact both female and male heart health include:
- High blood pressure
- Poor diet
- Smoking
- Alcohol use
- Lack of exercise
Your healthcare provider should consider all of these factors when assessing your heart health and whether you’re at higher risk for certain conditions.
“We can change the story,” says Holmes. “I help patients understand their traditional and female-specific heart disease risk factors. We talk about what they can’t control, such as genetics, and what they can control, like diet, exercise, sleep and stress management.”
Making lifestyle adjustments can also help you avoid preeclampsia in subsequent pregnancies, she adds.
Higher risk doesn’t mean heart disease is inevitable
Remember, just because you had preeclampsia during pregnancy doesn’t mean you’ll have heart issues later. It’s also not your fault. But it does mean you and your medical team have more information to help monitor your health and make lifestyle adjustments to minimize your future risk.
“Just because you had preeclampsia doesn’t mean something bad is going to happen,” says Holmes. “We just need to talk about it from a prevention standpoint.”
What postpartum care should look like after preeclampsia
Postpartum care often focuses on immediate recovery and infant health and women’s long-term cardiovascular risk may not be discussed. Women also may not realize they should tell their primary care provider or cardiologist about prior preeclampsia.
“Preeclampsia is so common that people sometimes think of it like having a cold,” says Holmes. “But if I told you having a cold three times in your life puts you at risk of having a heart attack later in life, you’d be more proactive about minimizing your risk. Preeclampsia should be looked at the same way. We can do a lot on the prevention side of things.”
Blood pressure monitoring is essential after delivery if you’ve had preeclampsia. Your body won’t immediately return to baseline after birth and it’s normal to experience postpartum blood pressure fluctuations.
If you used blood pressure medication during pregnancy, you may need medication adjustments or you may be able to wean off medication under your provider’s supervision.
You should receive a cardiovascular risk assessment four to six months postpartum, where your provider can review your:
- Blood sugar
- Cholesterol
- Inflammatory markers
- Thyroid function
- And other factors
Follow-up care can also help you plan for future pregnancies and other life stages, like menopause.
“Ask questions and advocate for yourself,” says Holmes. “If you don’t feel like you’re getting the information or support you need, seek a second opinion.”
What women can do now to protect their heart health
Here’s what you can do to protect your future cardiovascular health:
- Schedule regular primary care visits.
- Tell your provider about any history of preeclampsia or other pregnancy complications.
- Understand traditional and female-specific heart disease risk factors.
- Know your blood pressure and monitor it if recommended.
- Get regular physical activity (aim for 150 minutes of cardiovascular exercise each week, like walking, dancing, swimming, aerobics, jogging or cycling, and at least two strength training sessions per week).
- Focus on stress management and good sleep hygiene.
- Eat a healthy diet full of vegetables, fruits, healthy fats, fiber and lean protein.
- Address perimenopause or menopause symptoms with your provider when relevant.
- Seek support from specialty clinics, like the 4th Trimester Clinic or nutrition counseling, when available.
Preeclampsia can be frightening, but it can also provide valuable information. When patients and providers recognize it as part of a person’s cardiovascular history, they can take steps earlier to monitor blood pressure, address risk factors, plan for future pregnancies and protect long-term heart health.
“When we educate women about their risk, we can empower them to make lifestyle changes that help them avoid or minimize their risk of heart disease later in life,” says Holmes.
Schedule an appointment to talk with your provider about your pregnancy history and ways to support your long-term heart health.
