Women with a complication in the latest pregnancy, or in a previous pregnancy, face an elevated risk of developing cardiometabolic-renal conditions in subsequent years, suggests a UK study published online in the open access journal BMJ Medicine.
Gestational diabetes, high blood pressure in pregnancy, and postnatal depression were linked to a raised risk of four cardiometabolic-renal conditions - cardiovascular disease, type 2 diabetes, high blood pressure or chronic kidney disease, the authors suggest.
Pre-term birth, miscarriage, stillbirth, placental abruption (where the placenta separates from the inner wall of the womb before delivery), and babies born who are either small or large for their gestational age, were found to be associated with a raised risk of at least one cardiometabolic-renal condition.
The link between gestational diabetes and high blood pressure in pregnancy, and the subsequent development of type 2 diabetes, cardiovascular disease and chronic kidney disease has already been established in previous research.
For most other pregnancy complications such as miscarriage, stillbirth, placental abruption, preterm birth, small and large babies for gestational age, and postnatal depression, there is only limited evidence.
Most previous studies considered only the most recent pregnancy and few examined chronic kidney disease.
To fill this evidence gap, the authors searched a large primary care database to find women who had been pregnant and were registered with a GP in the UK between 1 January 2000 and 31 December 2022. This information was linked to hospital data to identify pregnancy complications.
They identified more than 1.4 million women who had been pregnant, with or without pregnancy complications, who were followed for an average of four years.
Gestational hypertension and pre-eclampsia more than tripled the rate of hypertension and approximately doubled the rate of chronic kidney disease in later life, with smaller increases for cardiovascular disease and type 2 diabetes, the researchers found.
Gestational diabetes was associated with a sevenfold higher rate of type 2 diabetes and increased rates for hypertension and cardiovascular disease.
The researchers also found less well established associations.
Post-natal depression following the latest pregnancy increased the rate of all four cardiometabolic-renal outcomes by 35-56%.
Miscarriage, stillbirth, placental abruption and preterm birth in the latest or in previous pregnancy were associated with modestly higher rates of one or more outcomes.
The authors say more research is needed to better understand the underlying mechanism behind these associations and to see whether adding a woman's pregnancy history to existing risk models makes it easier to predict her future heart, kidney and metabolic health.
A strength of the study is the use of a large GP database which reflects the UK population in terms of geography, deprivation and age.
This is an observational study and so does not imply that the pregnancy complication causes any subsequent disease. Rather the complication functions as a clinical marker of underlying risk, the authors say.
A limitation of the study is the lack of data on dietary habits and physical activity. Ethnicity data was also missing for around a fifth of the study group.
The authors conclude "Several pregnancy complications, including those occurring in previous pregnancies, were associated with an increased risk of cardiometabolic-renal conditions in the subsequent years after pregnancy."
They add: "These findings support obtaining a full reproductive history and using the postpartum period as an opportune time for risk assessment and preventative cardioprotective strategies in women with a history of adverse pregnancy outcomes."
