Is pregnancy a stress test?

Evidence for the "stress test" theory suggests that women with a history of preeclampsia, spontaneous abortion, preterm delivery, or delivery of a low birthweight infant are at increased risk for future disease. Knowing this in advance could allow physicians to address the problems women may face early enough so that they can still benefit from lifestyle and pharmacologic interventions.

Key Points

With the exception of gestational diabetes, conventional wisdom has long held that pregnancy complications were not associated with maternal disease later in life. With that in mind, research focused on the link between adult-onset chronic diseases such as cardiovascular disease (CVD) and diabetes and fetal disorders like intrauterine growth restriction and macrosomia (the "fetal programming" hypothesis).1 New research, however, has found a connection between pregnancy complications and later-life maternal disease, which suggests that pregnancy may be a "stress test" that might unmask pre- and subclinical illnesses that manifest later in life.2

Can pregnancy complications cause maternal disease later in life?

Proposed explanations

The second proposed explanation is that pregnancy-specific pathologic events result in damage or disease (Figure 1, center). This hypothesis, for instance, predicts that preeclampsia causes permanent changes in blood pressure, lipid metabolism, and endothelial function. Over time, this hastens or promotes atherosclerotic changes, which means that preeclampsia would be a direct cause of later-life cardiovascular events.