Women who develop high blood pressure during pregnancy may need more than lifestyle changes to protect their long-term heart health, according to a new study - the largest of its kind - published in The Lancet Obstetrics, Gynaecology & Women's Health.
The research found that while lifestyle programs offered modest health benefits, they did not significantly improve blood pressure within a year after birth, leaving women at continued risk of heart disease and other complications.1
The study, funded by NSW Health and led by Professor Amanda Henry from The George Institute for Global Health and Professor Mark Brown from St George Hospital, enrolled 525 women who had experienced hypertensive disorders of pregnancy (HDP) - which affect around 5-10% of pregnancies in Australia.2
Participants received either standard care, or one of two follow-up interventions six months after giving birth -a single specialised postpartum clinic educational and counselling visit, or postpartum clinic with an additional six-month phone-based lifestyle program.
While half of the women in the intervention groups saw positive improvements in weight or reduced waist size compared with 38% receiving standard care, their blood pressure remained largely unchanged 6-12 months after birth.1 Around 60% of women still had at least two cardiovascular risk factors at one year, and roughly 1 in 5 were taking blood pressure medication at six months.1
The six-month phone-based lifestyle change program offered no additional benefit over a single educational visit, and other health measures - including blood sugar and kidney function - showed little change.1
Lead author and Program Head of Women's Health at The George Institute for Global Health, Professor Amanda Henry, said the findings emphasise the need for earlier, more targeted interventions - including medication - in addition to lifestyle changes, to better protect women from cardiovascular risks associated with a hypertensive pregnancy.
"New mothers are highly motivated to look after their health, but the demands of caring for a newborn, fatigue, and returning to work can all make major lifestyle changes challenging. While structured programs did help some women achieve important health improvements like weight loss, most saw little change in their blood pressure, leaving them at ongoing risk.
This highlights the need for postpartum care that combines lifestyle support with medical monitoring and treatment, recognising that women shouldn't be expected to manage these risks alone.
By:Professor Amanda Henry
Program Head of Women's Health at The George Institute for Global Health
A call for better postpartum care
Hypertensive disorders of pregnancy (HDP) - including chronic hypertension, gestational hypertension, and preeclampsia - are among the leading causes of illness and death for mothers and babies, increasing the risk of complications such as maternal kidney and liver injury, preterm births, poor fetal growth, and stillbirths.3
Beyond pregnancy, the effects can be long-term, with women who have had HDP at significantly higher risk of developing chronic conditions such as heart disease, kidney disease, and type 2 diabetes later in life.4-9 Even a single episode of preeclampsia can increase a woman's lifetime risk of heart disease 2-5 fold, with the danger climbing further for those with preterm or chronic high blood pressure in pregnancy.6,7,9
Despite these established risks, there has been limited research on how best to support women after a hypertensive pregnancy.10,11 Most current guidelines for preventing heart disease are based on studies conducted in older, male populations, and do not reflect the needs or realities of new mothers.10,11
Professor Henry said that earlier postpartum follow-up, closer blood pressure monitoring, and the use of medications alongside lifestyle counselling were needed To better protect women's long term heart health.
"It's clear that lifestyle advice, while essential, is not enough on its own, and we urgently need a more proactive, structured approach, including preventive medications for those at highest risk, to protect women from the long-term heart risks after a hypertensive pregnancy.
By bringing structured cardiovascular screening and management into routine postnatal care, we have a real chance to change outcomes and reduce the burden of heart disease for countless women starting or growing their families.
By:Professor Henry
About the Study
The study was a large, randomised trial designed to evaluate the effectiveness of postpartum lifestyle interventions for women who experienced hypertensive disorders during pregnancy. Between 2019 and 2023, researchers screened 2,652 women and enrolled 525 participants, with 399 completing the 12-month follow-up. The study aimed to determine whether structured follow-up and tailored lifestyle programs could improve cardiovascular health in this high-risk population.
Participants were assigned to one of three groups six months after giving birth - standard care, a single education clinic visit, or a six-month phone-based lifestyle program. Researchers measured changes in blood pressure, weight, and waist size between six and twelve months postpartum, alongside other health indicators such as diet, exercise, blood sugar, and kidney function.
References
1. Henry A, Roberts LM, Kotevski DP, Arnott C, Beech A, Brew BK, Chambers GM, Craig ME, Davis GK, Denney-Wilson E, Fitzgerald O, Gow ML, Hennessy A, Hyett J, Kirwin E, Lee VW, Makris A, Mann L, Pettit F, Ruhotas A, Salisbury J, Brown MA. Lifestyle intervention versus usual care for improving cardiovascular risk profile in the first year after hypertensive disorders of pregnancy in Australia (Blood Pressure Postpartum): a randomised controlled trial. Lancet Obstetrics, Gynaecology and Women's Health 2026. doi.org/10.1016/S3050-5038(25)00148-7
2. Beech A, Mangos G. Management of hypertension in pregnancy. 2021. Australian Prescriber. Oct 1;44(5).
3. Magee LA, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension. 2022 Mar;27(27):148-69.
4. Wu P, et al. Preeclampsia and Future Cardiovascular Health. Circulation: Cardiovascular Quality and Outcomes. 2017 Feb;10(2).
5. Khashan, A., et al., Preeclampsia and risk of end stage kidney disease: A Swedish nationwide cohort study. PLoS Med, 2019. 16(7): p. e1002875.65. Leon, L., et al., Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records: A CALIBER Study. Circulation, 2019. 140: p. 1050-1060.
7. Arnott, C., et al., Maternal cardiovascular risk after hypertensive disorder of pregnancy. Heart, 2020. 106: p. 1927-33.
8. Wang, Z., et al., Hypertensive disorders during pregnancy and risk of type 2 diabetes in later life: a systematic review and meta-analysis. Endocrine, 2017. 55(3): p. 809-821.
9. Theilen, L., et al., All-cause and cause-specific mortality after hypertensive disease of pregnancy. Obstetrics & Gynecology, 2016. 128(2): p. 238-44.
10. Magee, L., et al., The Hypertensive Disorders of Pregnancy: The 2021 International Society for the Study of Hypertension in Pregnancy Classification, Diagnosis & Management Recommendations for International Practice. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2022. 27: p. 148-169
11. Lui, N., G. Jeyaram, and A. Henry, Postpartum interventions to reduce long-term cardiovascular disease in women after Hypertensive Disorders of Pregnancy: a systematic review. Frontiers in Cardiovascular Medicine, 2019. 2019.
