Pregnancy Complications May Signal Heart Risk Years Before Standard Screening

Heart disease is the leading cause of death in women, yet most tools doctors use to estimate a patient’s cardiovascular risk were built and tested in older populations. That gap leaves younger women, including those with pregnancy-related health complications, largely outside the scope of standard risk assessments. A study from McGill University, published in JACC: Advances, set out to change that.

“Millions of women who give birth each year are never considered candidates for cardiovascular risk assessment simply because of their age,” explained co-author Kristian Filion, Ph.D., professor in the Departments of Medicine and of Epidemiology, Biostatistics and Occupational Health.

Building a Model From Postpartum Health Records

Investigators, including Robert Platt, Ph.D., professor in the Department of Epidemiology, Biostatistics and Occupational Health and director of the School of Population and Global Health at McGill University, developed and validated a prediction model specifically for women of reproductive age. The team used health records from 262,891 women ages 15 to 45 in the U.K.’s Clinical Practice Research Datalink, each with one randomly selected delivery between 1999 and 2017, and followed them for a median of about four years after childbirth.

Platt noted that while pregnancy complications have long been linked to future heart risk, he added, there has not been a reliable way to identify which younger women face the highest risk.

Factors Standard Tools Miss

Over the follow-up period, 943 women in the study experienced a cardiovascular event during the follow-up period. Using statistical modeling techniques designed to select the most relevant predictors, investigators found that beyond traditional cardiovascular risk factors, several pregnancy-related and social factors meaningfully improved the model’s ability to flag risk. These included hypertensive disorders of pregnancy, gestational diabetes, preterm birth, small-for-gestational-age birth weight, polyendocrine metabolic ovarian syndrome, prior oral contraceptive use, depression, thyroid disorders, social deprivation, and a history of pregnancy complications or higher parity.

None of these factors are part of conventional cardiovascular risk calculators, which typically focus on measures like cholesterol, blood pressure and age, without accounting for reproductive history.

How Well the Model Performed

When tested for accuracy, the model showed what investigators describe as modest discrimination, meaning it could distinguish higher-risk from lower-risk women better than chance, but not with high precision. Its calibration, meaning how closely its risk estimates matched what actually happened to participants, was good. Investigators say this level of performance highlights the value of including sex-specific risk factors, even as the tool itself needs further refinement before clinical use.

What Earlier Risk Detection Could Mean

The findings suggest some women, particularly younger women often considered low-risk by default, may face elevated cardiovascular risk earlier than current screening practices recognize. If integrated into routine postpartum care, Filion said, a tool like this could enable earlier monitoring, lifestyle counseling or referral to a specialist, potentially helping prevent a heart attack or stroke later in life.

Next Steps

The research team’s next step is validating the model using data from Canada and the United States to see whether it performs consistently across different health care systems and populations. Longer term, the goal is to build a practical calculator into electronic health records so clinicians can identify higher-risk patients during routine postpartum visits rather than waiting until later in life when standard screening typically begins.