Women who experience pregnancy complications such as gestational diabetes, preeclampsia, or preterm delivery have a significantly increased long-term risk of developing peripheral artery disease (PAD) later in life, according to a new study published July 21st in the open access journal PLOS Medicine by Casey Crump of the University of Texas, US, and colleagues.
PAD, a condition in which narrowed arteries reduce blood flow to the limbs, affects more than 230 million people worldwide and is a strong predictor of future stroke, ischemic heart disease, and premature mortality. Adverse pregnancy outcomes have been identified as risk factors for other cardiovascular diseases, but their association with long-term PAD risk had not been well established.
In the new study, researchers analyzed data from 2,201,446 women who had a singleton delivery in Sweden between 1973 and 2015, following them for PAD diagnoses from nationwide inpatient, outpatient, and primary care records through 2018. Five adverse pregnancy outcomes were examined: preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes.
In 54 million person-years of follow-up, 13,211 women (0.6%) were diagnosed with PAD, at a median age of 62. All five adverse pregnancy outcomes were independently associated with increased PAD risk. At 30–46 years after delivery, adjusted hazard ratios were highest for gestational diabetes (HR 3.83, 95% CI 3.20–4.59), followed by small for gestational age (HR 1.74, 95% CI 1.65–1.83), other hypertensive disorders (HR 1.61, 95% CI 1.21–2.15), preterm delivery (HR 1.58, 95% CI 1.48–1.70), and preeclampsia (HR 1.28, 95% CI 1.20–1.37). Women with multiple adverse pregnancy outcomes had further increases in risk. These findings were largely unexplained by shared familial factors in co-sibling analyses.
"Because this was a relatively young cohort, the risks of PAD following adverse pregnancy outcomes may be even higher as women reach older ages when PAD is more likely to manifest," the authors write. "Women with pregnancy complications may warrant early cardiovascular risk assessment and long-term clinical follow-up given their higher subsequent risk of PAD."
The authors add, "Pregnancy is a "natural stress test" that may reveal higher cardiovascular risks in early adulthood. In a population of >2 million women, we found that all 5 major adverse pregnancy outcomes (preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes) are independently linked with higher risks of peripheral artery disease up to 46 years later. Women with pregnancy complications need early and long-term follow-up with their physician to reduce their lifetime risk of peripheral artery disease and other cardiovascular diseases."
In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: https://plos.io/4yoG0M0
Citation: Crump C, Wei J, Sundquist J, Sundquist K (2026) Adverse pregnancy outcomes and long-term risk of peripheral artery disease: A cohort study. PLoS Med 23(7): e1004821. https://doi.org/10.1371/journal.pmed.1004821
Author countries: United States, Sweden
Funding: see manuscript
