Long-Term Effects of Preeclampsia and Other Pregnancy Complications on Heart Health
Preeclampsia, high blood pressure in pregnancy, gestational diabetes and preterm birth are linked with higher heart and metabolic risk for years after delivery. Learn which complications count, what the research shows, and which checks make that history useful.
- Published
- November 2, 2026
- Read time
- 7 min read
- Medically reviewed by
-
Rhonda Collins, FNP-C
Table of contents
Preeclampsia, high blood pressure in pregnancy, gestational diabetes and preterm birth do not end at delivery. Major medical groups now treat them as part of a woman’s long-term heart history, because they are linked with higher heart and metabolic risk for years afterward [1][2]. That history becomes useful when it leads to earlier checks of blood pressure, blood sugar and cholesterol.
In October 2026, the American Heart Association (AHA), the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine published joint guidance that treats pregnancy as a time when heart risk “may emerge or be unmasked” [2]. In the AHA’s words, “pregnancy history is heart history” [1].
Which pregnancy complications count as heart risk factors
The AHA and its partner groups recognize pregnancy complications such as these as female-specific risk enhancers for heart disease [1]:
- High blood pressure in pregnancy (hypertensive disorders of pregnancy)
- Preeclampsia
- Gestational diabetes
- Preterm birth
- A baby who is small for gestational age
- Stillbirth
A risk enhancer is a factor that can shift how a clinician weighs your overall heart risk alongside the usual measures, such as age, blood pressure, cholesterol and smoking. The 2026 American College of Cardiology (ACC) and AHA cholesterol guideline names preeclampsia and gestational diabetes among its reproductive risk enhancers, together with early menopause [3][4].
The medical groups describe pregnancy as a biological “stress test” [1]. The extra load on the heart, blood vessels and metabolism can reveal a tendency toward high blood pressure or high blood sugar that was not visible before.
Long-term effects of preeclampsia: what the research shows
Preeclampsia is associated with roughly twice the risk of ischemic heart disease and almost four times the risk of high blood pressure in the years after pregnancy. These figures come from a 2007 BMJ systematic review and meta-analysis that pooled cohort studies covering 3,488,160 women, 198,252 of whom had preeclampsia [5].
Compared with women who did not have preeclampsia, women who did had [5]:
| Outcome | Relative risk | Average follow-up |
|---|---|---|
| High blood pressure | 3.70 | 14.1 years |
| Ischemic heart disease | 2.16 | 11.7 years |
| Stroke | 1.81 | 10.4 years |
| Venous thromboembolism | 1.79 | 4.7 years |
| Death from any cause | 1.49 | 14.5 years |
These are associations, not proof that preeclampsia causes heart disease. The authors wrote that the link might reflect a cause shared by preeclampsia and heart disease, an effect of preeclampsia on later disease, or both [5]. They concluded that a history of preeclampsia should be considered when assessing a woman’s heart risk [5]. The same review found no increase in cancer risk after preeclampsia [5].
Gestational diabetes and later type 2 diabetes risk
Women who had gestational diabetes were almost 10 times as likely to develop type 2 diabetes as women whose pregnancies had normal blood sugar. A 2020 BMJ meta-analysis of 20 studies, covering 1,332,373 people including 67,956 women with gestational diabetes, found a pooled relative risk of 9.51 [6].
Across the studies, roughly 10% to 16% of women with past gestational diabetes went on to develop type 2 diabetes during follow-up, depending on the population studied [6]. The American Diabetes Association (ADA) estimates the lifetime risk of diabetes after gestational diabetes at 50% to 60% [7].
Type 2 diabetes matters for the heart because diabetes is itself a major heart disease risk factor. That is one reason a blood sugar check belongs in a heart-risk review after gestational diabetes. For a fuller look at diabetes testing, see the two key blood tests for diabetes.
What to check after a pregnancy complication
After a pregnancy complication, the useful checks are blood pressure, blood sugar and cholesterol, started earlier and repeated over time. Each one follows a measurable risk the research links to pregnancy history.
Blood pressure after high blood pressure in pregnancy
High blood pressure is the outcome most strongly linked to preeclampsia in the BMJ review [5]. Follow-up is often missed: the AHA reports that only about 60% of U.S. women with high blood pressure complications in pregnancy get follow-up care for their blood pressure within six months of delivery [1]. ACOG advises that women with hypertensive disorders of pregnancy be counseled on timely follow-up with their obstetric care provider or primary care doctor [8].
If you had preeclampsia or high blood pressure in pregnancy, make sure your primary care doctor knows, because that history does not always travel from obstetric records to later care. Home and clinic readings over the years show whether blood pressure is starting to rise. For what a spike during pregnancy itself can mean, see blood pressure spikes in pregnant women. For ways to track heart risk between visits, see how to check your heart attack risk at home.
Blood sugar after gestational diabetes
The ADA’s 2026 Standards of Care set two steps after gestational diabetes [7]:
- A 75-gram oral glucose tolerance test at 4 to 12 weeks after delivery, using standard non-pregnancy criteria. The ADA recommends this test over HbA1c at that stage, because HbA1c can be lowered after pregnancy by faster red blood cell turnover and by blood loss at delivery.
- Lifelong screening for type 2 diabetes or prediabetes every 1 to 3 years, even if the first postpartum test was normal. The ADA says this ongoing screening may use any of the recommended diabetes tests, which include HbA1c.
HbA1c reflects your average blood sugar over about 2 to 3 months, and it does not require fasting. It measures blood sugar, not heart risk directly. Its role here is to catch prediabetes or type 2 diabetes early, since both raise long-term heart risk. Mito offers the Hemoglobin A1c (HbA1c) Blood Test on its own, and results sit in your Mito dashboard so you can compare them across the years.
Cholesterol as part of a heart-risk review
The 2026 ACC/AHA cholesterol guideline estimates heart risk from measures such as cholesterol and blood pressure, then refines it with risk enhancers that include preeclampsia and gestational diabetes [3][4]. Mito’s Lipid Panel measures total cholesterol, HDL cholesterol and triglycerides, and reports LDL cholesterol or non-HDL cholesterol depending on the lab. Knowing those numbers and your pregnancy history together gives a clinician a fuller picture than either alone. For more on how cholesterol changes across a woman’s life, see what causes high cholesterol in women.
What a pregnancy complication does not mean
A pregnancy complication does not make heart disease certain, but it is a reason to start checking blood pressure, blood sugar and cholesterol earlier. Regular results over the years turn a past complication into information you and your doctor can act on.
References
- American Heart Association Newsroom. Leading health groups redefine heart health for girls and women. October 26, 2026.
- Khan SS, Grobman WA, Angell S, et al. Consensus guidance for the female-specific prevention and management of cardiovascular disease: a scientific statement from the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine. Circulation. 2026. doi:10.1161/CIR.0000000000001482.
- American Heart Association Newsroom. ACC/AHA issue updated guideline for managing lipids, cholesterol. March 13, 2026.
- 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia. J Am Coll Cardiol. 2026. doi:10.1016/j.jacc.2025.11.016.
- Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.
- Vounzoulaki E, Khunti K, Abner SC, et al. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ. 2020;369:m1361.
- American Diabetes Association Professional Practice Committee. 15. Management of diabetes in pregnancy: Standards of Care in Diabetes 2026. Diabetes Care. 2026;49(Suppl 1):S321-S338. doi:10.2337/dc26-S015.
- American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstet Gynecol. 2018;131(5):e140-e150.
Frequently asked questions
Does preeclampsia cause long-term damage?
Preeclampsia is linked with higher heart and blood vessel risk for years after delivery. In a review of nearly 3.5 million women, it was associated with about 3.7 times the risk of high blood pressure and about twice the risk of ischemic heart disease over the following decade or more. The researchers could not tell whether preeclampsia causes that risk, shares a cause with it, or both.
Can I live a long life after preeclampsia?
Many women do. The same review found overall mortality about 1.5 times higher after preeclampsia across roughly 14 years of follow-up, which is a higher average risk across a large group, not a prediction for any one person. Medical groups use this history as a reason to check blood pressure, blood sugar and cholesterol earlier, so that any rise is found and managed sooner.
Should I see a cardiologist after preeclampsia?
Most follow-up after preeclampsia starts with your obstetric care provider and then your primary care doctor, who can track blood pressure, blood sugar and cholesterol over time. A cardiologist becomes part of care when those checks, symptoms or other findings call for it. What matters most is that whoever provides your ongoing care knows about the pregnancy complication.
Does your blood pressure go back to normal after preeclampsia?
A normal reading in the weeks after delivery does not erase the later risk. In the BMJ review, the higher risk of high blood pressure appeared over an average of 14 years of follow-up. That is why a blood pressure check belongs in routine care for years, not only in the weeks after birth.
Does gestational diabetes increase heart disease risk?
Gestational diabetes is listed with preeclampsia as a reproductive risk enhancer in the 2026 ACC/AHA cholesterol guideline, which means it can shift how a clinician weighs heart risk. Its clearest long-term link is with type 2 diabetes, which itself raises heart disease risk.
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