Pregnancy isn't just a nine-month event; it's a window into a woman's lifelong heart health. A groundbreaking three-part series published in The Lancet and The Lancet Obstetrics, Gynaecology & Women's Health reveals that pregnancy complications and cardiovascular changes during pregnancy can unmask hidden heart disease and predict a woman's risk of cardiovascular problems decades later.

Why Should Doctors Treat Pregnancy as a Heart Health Screening Tool?

Cardiovascular disease remains one of the leading causes of maternal mortality worldwide, yet pregnancy-related heart complications are often overlooked or managed inconsistently across healthcare settings. The new series, led by researchers at Inova Schar Heart and Vascular in Falls Church, Virginia, calls for a fundamental shift in how doctors approach women's health: viewing pregnancy not as an isolated event, but as a critical opportunity to assess lifelong cardiovascular risk.

The three papers examine different stages of this continuum, from cardiovascular disease during pregnancy itself to the long-term heart health implications of adverse pregnancy outcomes. According to the research, certain pregnancy complications serve as red flags for future heart disease risk:

• Hypertensive Disorders: Gestational hypertension and preeclampsia affect an estimated 5 to 10 percent of pregnancies worldwide and are leading causes of maternal and fetal illness and death. These conditions are now recognized as complex placental and cardiovascular diseases, not just temporary pregnancy-related issues.
• Gestational Diabetes: Elevated blood sugar during pregnancy can signal increased cardiovascular risk later in life, even if the condition resolves after delivery.
• Preterm Birth: Delivering before 37 weeks is associated with substantially higher risk of cardiovascular morbidity and mortality in the years following pregnancy.

"We have an opportunity to change the trajectory of women's health. The cardiovascular changes that occur during pregnancy can reveal heart disease that was previously unrecognized, while complications such as hypertension, preeclampsia, gestational diabetes and preterm birth can signal increased cardiovascular risk later in life," said Dr. Garima Sharma, Martha Schar Chair of Women's Cardiovascular Health at Inova.

Dr. Garima Sharma, Martha Schar Chair of Women's Cardiovascular Health at Inova Schar Heart and Vascular

What Does Integrated Pregnancy Heart Care Look Like?

The research emphasizes the importance of multidisciplinary "cardio-obstetrics" teams, where cardiologists, maternal-fetal medicine specialists, and obstetricians work together before, during, and after pregnancy. This coordinated approach addresses a critical gap: women who experience pregnancy complications often lose cardiovascular follow-up care once they leave the delivery room.

The series calls for several key changes to standard maternity care:

• Preconception Counseling: Women with known cardiovascular disease should receive counseling about pregnancy risks before conception, allowing for individualized risk assessment and medication review.
• Earlier Detection: Hypertensive disorders and other complications need earlier detection and more personalized approaches to care, with continued research into risk prediction and prevention strategies.
• Postpartum Cardiovascular Follow-Up: Women who experience adverse pregnancy outcomes must receive appropriate cardiovascular care long after delivery, when early intervention can reduce long-term disease risk.
• Pregnancy History Integration: A woman's pregnancy history should be incorporated into her cardiovascular risk assessment and communicated to all her healthcare providers, not just her obstetrician.

"Pregnancy is not simply a nine-month event or a moment in time. It is an opportunity to understand a woman's cardiovascular health across her lifetime. We need to recognize cardiovascular risk before pregnancy, provide coordinated care when complications arise, and make sure that women who experience an adverse pregnancy outcome receive appropriate cardiovascular follow-up care long after delivery," explained Dr. Sharma.

Dr. Garima Sharma, Martha Schar Chair of Women's Cardiovascular Health at Inova Schar Heart and Vascular

How Can Metformin Help Reduce Preterm Birth Risk?

While the Lancet series focuses on cardiovascular connections, emerging research also highlights practical interventions for high-risk pregnancies. A major analysis of seven randomized, placebo-controlled trials involving 2,297 pregnancies found that metformin, a low-cost oral medication commonly used to manage blood sugar, significantly reduced preterm birth risk among women at high metabolic risk.

Metformin works by helping the body use insulin more effectively to lower blood sugar. Among pregnant women taking metformin, those at high metabolic risk had 35 percent lower odds of giving birth before 37 weeks compared to those receiving a placebo. The benefits were even more dramatic for very early preterm birth: the rate of births before 34 weeks was cut in half, dropping to 2.2 percent in the metformin group compared to 4.4 percent in the placebo group.

Importantly, metformin did not prevent gestational diabetes overall, but it did offer significant protective benefits against premature delivery. Among women who did deliver prematurely despite metformin use, pregnancy was prolonged by an average of 11 days, giving babies additional time to develop in the womb.

Preterm birth remains a leading cause of mortality and morbidity for mothers and babies. In Australia alone, more than 26,000 babies, around 8 percent of all births, are born prematurely each year, putting infants at risk of respiratory distress, developmental complications, and prolonged stays in neonatal intensive care.

"We found women taking metformin had fewer births before 37 weeks. This included halving the rate of births before 34 weeks, down to 2.2 percent, compared with 4.4 percent in the placebo group. Among those who did deliver prematurely, pregnancy was prolonged by an average of 11 days for women on metformin," noted Associate Professor Aya Mousa, head of Diabetes, Metabolic and Reproductive Health Research at the Monash Centre for Health Research & Implementation.

Associate Professor Aya Mousa, head of Diabetes, Metabolic and Reproductive Health Research at the Monash Centre for Health Research & Implementation

Why Are Women With Multiple Chronic Conditions at Such High Risk During Pregnancy?

A new three-year UK study is addressing another critical gap in maternity care: pregnant women living with multiple long-term health conditions. More than one in six pregnant women in the UK are managing multiple chronic conditions such as diabetes, high blood pressure, heart disease, and mental health disorders, yet there are currently no defined care requirements for this vulnerable population.

The statistics are sobering. Pregnant women with multiple long-term health conditions face twice the risk of preterm birth and are nine times more likely to die during pregnancy compared to women without these complications. Additionally, more than 80 women die each year in the UK due to pregnancy-related complications, many of whom have underlying chronic conditions.

Women living with multiple conditions often face fragmented care, including medication changes, conflicting advice from different healthcare teams, and a lack of appropriate follow-up for their health conditions after birth. The new research, led by the University of Aberdeen and Birmingham City University with support from the National Institute for Health and Care Research (NIHR), aims to develop a "care bundle," a package of evidence-led care designed to guide safe maternity care for these women throughout pregnancy, birth, and the postnatal period.

"Too many women living with more than one long-term health condition are falling through the gaps between different parts of the health system during pregnancy, when they most need coordinated support. This research will bring together expertise from across maternity and specialist care to build a care bundle that gives women and health professionals clear, consistent guidance, before, during and after birth," stated Professor Jane Sandall, professor of social science and women's health at King's College London.

Professor Jane Sandall, professor of social science and women's health at King's College London

The care bundle will include guidance on medication management, communication between healthcare teams, midwifery care, and postnatal handovers. Researchers will also work with people who have lived experience of maternity care to help shape and test the bundle, ensuring it addresses real-world challenges women face.

Together, these developments represent a significant shift in how healthcare systems approach pregnancy: moving away from treating pregnancy complications as isolated events and instead using them as opportunities for prevention and lifelong health surveillance. By recognizing the connections between pregnancy health and cardiovascular disease, implementing proven interventions like metformin for high-risk pregnancies, and providing coordinated care for women with multiple chronic conditions, clinicians have the potential to improve maternal outcomes and protect women's health for decades to come.