Key takeaways:
- Hypertensive disorders of pregnancy (HDP) were linked to significantly increased risks of heart failure, stroke, heart attack, coronary artery disease, and death within 5 years postpartum.
- Nearly 20% of more than 218,000 births analyzed involved HDP, with most diagnoses occurring during a first pregnancy.
- Patients with HDP more often had additional cardiovascular risk factors, including obesity, diabetes, smoking, and hyperlipidemia.
- Risk severity rose with HDP severity, with the highest cardiovascular risks observed in women with chronic hypertension and eclampsia.
- Emerging research suggests a unique HDP–preterm–LGA phenotype may reveal new biological mechanisms influencing maternal cardiovascular outcomes.
Intermountain Health researchers have found increased risks of postpartum cardiovascular complications from any hypertensive disorder of pregnancy (HDP), presenting their findings at the American Heart Association Scientific Sessions 2025 on November 9, 2025.1
HDPs were linked to significantly increased risks of stroke, heart attack failure, and death within 5 years postpartum. According to investigators, this highlights the growing body of evidence about the association between hypertension during pregnancy and long-term maternal health risks collected within the past 2 decades.
“Any form of hypertension during pregnancy significantly increases cardiovascular risk and the risk of death,” said Kismet Rasmusson, NP, advanced practice clinician at Intermountain Health and principal investigator. “This risk is present in women with chronic hypertension prior to pregnancy, and it’s even more pronounced when compounded by severe forms of HDP.”
Comorbidities in hypertension
The retrospective study included 218,141 live births between 2017 and 2024. These births were performed by 157,606 patients attending 22 hospitals affiliated with Intermountain Health. Chronic hypertension and HDP diagnoses were obtained from electronic medical records and included gestational hypertension, preeclampsia, and eclampsia.
During a mean 5-year follow-up period, patients were monitored for cardiovascular disease. An HDP diagnosis was reported in 19.7% of the study population, most of whom were diagnosed during their first birth.
These patients were significantly more likely to present with cardiovascular risk factors such as obesity, diabetes, smoking, depression, lower socioeconomic status, and hyperlipidemia.
Postpartum cardiovascular risks observed
Heart failure was the greatest cardiovascular risk in patients with HDP, with a 3- to 13-fold increase vs those without HDP. Additional risk included:
- 2- to 17-fold increase for stroke
- 3- to 7-fold increase for heart attack
- 2- to 7-fold increase for coronary artery disease
- 1.4- to 4-fold increase for death
A correlation was also reported between HDP severity and the magnitude of cardiovascular risk. The greatest risk of future cardiovascular events vs women without HDP was reported in those with chronic hypertension and eclampsia.
These results indicated long-term maternal health risks following HDP. However, investigators noted that many pregnant women are unaware of these increased risks.
“We need to do a better job identifying women with these risk factors and ensuring they receive appropriate care before, during, and after pregnancy,” said Rasmusson. “This is especially critical for those with severe forms of HDP.”
Unique HDP phenotype observed
This association is supported by recent research about a phenotype for cardiovascular disease observed in women with HDP delivering a large for gestational age (LGA) infant preterm.2 In a recent discussion, Sage Wyatt, PhD, postdoctoral researcher at Utrecht University, highlighted the implications of this data.
Wyatt highlighted how the phenotype challenges longstanding assumptions about fetal growth patterns in HDP, as small-for-gestational-age (SGA) infants have long been recognized as a risk factor in mothers. However, this new data indicates distinct biological mechanisms influencing maternal symptoms.
According to Wyatt, future research should expand on this HDP–preterm–LGA subtype to determine why some hypertensive pregnancies result in LGA infants while others result in SGA infants. Additionally, more data is needed to determine whether these differences result in variations in long-term cardiovascular disease risk.
“I think the gold in this research is really taking the time to think outside the box and consider what hasn’t been considered in the past,” said Wyatt.
References
- Any form of hypertension during pregnancy significantly increases postpartum cardiovascular risk including death, new study finds. Intermountain Health. November 9, 2025. Accessed November 19, 2025. https://www.eurekalert.org/news-releases/1104510.
- Wyatt S. Sage Wyatt, PhD, discusses cardiovascular risk assessment through HDP. November 10, 2025. Accessed November 19, 2025. https://www.contemporaryobgyn.net/view/sage-wyatt-phd-discusses-cardiovascular-risk-assessment-
