Pregnancy can be a warning light.
Rutgers researchers found that cardiovascular health during pregnancy was linked to how soon women were later diagnosed with chronic hypertension or metabolic conditions after giving birth.
The study , published in JAMA Network Open, followed 1,225 pregnancies using about seven years of electronic health record data.
The researchers, led by Ellen C. Francis , an assistant professor in the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health, found that within seven years after delivery, 40% of women were diagnosed with a cardiometabolic condition, and women with poorer cardiovascular health scores during pregnancy were diagnosed much sooner than women with better scores. This finding was generally similar among women with uncomplicated pregnancies.
These results suggest that clinicians may need to look beyond pregnancy complications such as gestational diabetes and hypertensive disorders of pregnancy when assessing long-term risk.
"Pregnancy complications are important indicators of future risk, but relying on those diagnoses alone may miss women whose cardiovascular health is already less favorable," Francis said. "A broader assessment could potentially identify additional women who may benefit from prevention and health-promotion services after delivery."
Francis and her colleagues used data from a pregnancy cohort to create a pregnancy-adapted cardiovascular health score based on the American Heart Association's Life's Essential 8 framework . The score included health factors and behaviors assessed during pregnancy, including body mass index, glucose regulation, blood pressure or hypertensive pregnancy conditions, smoking, diet, physical activity and sleep.
The researchers then linked the pregnancy data with about seven years of electronic health record surveillance to examine how cardiovascular health during pregnancy was associated with the timing of new hypertensive, metabolic or cardiovascular diagnoses after delivery.
Among 1,225 pregnancies, women who didn't have chronic disease during pregnancy yet received poorer cardiovascular health scores were diagnosed with chronic hypertensive and metabolic conditions sooner than women with better scores. The pattern remained when researchers limited the analysis to women who hadn't experienced gestational diabetes or a hypertensive disorder of pregnancy.
The study found fewer cardiovascular disease events, so Francis said those findings should be interpreted cautiously. But the broader pattern points to pregnancy as a period when clinicians may be able to identify early signs of cardiometabolic risk.
"There is growing recognition that pregnancy can reveal a woman's underlying susceptibility to future cardiometabolic disease," Francis said. "Our findings extend that work by showing that a broader assessment of cardiovascular health during pregnancy may provide information beyond the presence or absence of gestational diabetes or hypertensive disorders of pregnancy."
The findings also support viewing cardiovascular health as a continuum, Francis said.
"Women do not suddenly become high-risk only when they cross a diagnostic threshold," she said. "Less favorable levels across several health factors and behaviors may collectively identify elevated risk."
Several parts of the pregnancy-adapted score are already collected during routine prenatal care, including body mass index, blood pressure, smoking status, pregnancy diagnoses and results from glucose testing. Other factors, including diet, physical activity and sleep, aren't assessed as consistently but could be captured through brief questionnaires or incorporated into electronic health records.
Francis said the goal isn't simply to assign women a score. It is to use that information to connect them with care and services after delivery, including primary care, nutrition and physical activity programs, community health workers, doulas or community-based programs such as the National Diabetes Prevention Program .
"This is also where continuity of insurance coverage and care becomes important," Francis said. "Extended postpartum Medicaid coverage may provide a greater window in which women identified as having poorer cardiovascular health during pregnancy can receive follow-up, risk-factor management and referrals to prevention services."
The study didn't evaluate a specific intervention or insurance policy. More research is needed to determine how pregnancy-based cardiovascular health assessment can be translated into improved long-term health outcomes.
For health care professionals, Francis said the study points to a practical opportunity.
"Pregnancy is a period when many women have more frequent contact with the health care system than they do at other points in early adulthood," she said. "This may create an important opportunity to assess cardiovascular health, discuss long-term risk and establish connections to primary and preventive care."
But assessment alone isn't enough, Francis said.
"A broader cardiovascular health assessment may support a more equitable approach than waiting for women to develop a major pregnancy complication or an overt chronic disease," she said. "However, assessment must be paired with accessible, affordable and culturally appropriate services after delivery."
