A new study has determined that mothers who experienced pre-pregnancy hypertension, hypertensive disorders of pregnancy (HDP), diabetes, or any combination of these three diseases are at greatly elevated risks of coronary heart disease (CHD) and all-cause mortality in the first five years postpartum. The study was published in BMC Cardiovascular Diabetology journal by Angela M. and fellow researchers. These results underscore the imperative to better screen for risk factors and provide follow-up care for such women, particularly in racial groups that are disproportionately affected.
This retrospective cohort analysis examined information from 430,545 women aged 12–49 with at least one singleton live birth in South Carolina during 2004–2016. The cohort consisted of 59.2% non-Hispanic White (NHW), 31.4% non-Hispanic Black (NHB), and 9.4% Hispanic women. Birth certificate and hospitalization/emergency department (ED) data were used to determine women with pre-pregnancy hypertension, HDP (preeclampsia, eclampsia, and gestational hypertension), and pre-pregnancy and gestational diabetes. Incident CHD and all-cause mortality were followed through hospitalization/ED and death certificate records over a follow-up duration of up to 14 years.
The Cox proportional hazard models were utilized to estimate the adjusted risk of CHD and all-cause death according to the presence of individual or combined conditions (diabetes, HDP, pre-pregnancy hypertension). The aim was to evaluate the independent and cumulative effect of such conditions on maternal cardiovascular outcomes at 5 years post-delivery and during the full duration of the study. The analysis was also controlled for age, race, and other complications and comorbidities at delivery.
Key Findings
Within five years of giving birth, women with any one of the three maternal conditions were at significantly higher risk of developing coronary heart disease:
Diabetes on its own was linked with a 57% increased risk of CHD (HR = 1.57; 95% CI: 1.28–1.92).
HDP on its own increased the risk by 85% (HR = 1.85; 95% CI: 1.60–2.15).
Both HDP and diabetes were associated with a 129% increased risk (HR = 2.29; 95% CI: 1.73–3.03).
HDP with pre-pregnancy hypertension had a 213% increased risk (HR = 3.13; 95% CI: 2.66–3.68).
Women with all three conditions had an almost five-fold higher risk (HR = 4.87; 95% CI: 3.95–6.01).
In the analysis of all-cause mortality at five years:
Diabetes alone had a 34% increased risk (HR = 1.34; 95% CI: 1.01–1.78).
HDP with pre-pregnancy hypertension had a 53% increased risk (HR = 1.53; 95% CI: 1.15–2.03).
All three conditions together were associated with a 125% higher risk of death (HR = 2.25; 95% CI: 1.51–3.36).
HDP alone or HDP with diabetes did not have statistically significant higher mortality risk.
This large-scale investigation offers strong evidence that the co-existence and concomitance of diabetes, pre-pregnancy hypertension, and hypertensive disorders during pregnancy excessively raise the risk of coronary heart disease development and all-cause mortality in subsequent years post-childbirth.
Reference:
Malek, A.M., Wilson, D.A., Mateus, J. et al. Maternal coronary heart disease and mortality following hypertensive disorders of pregnancy and/or diabetes. Cardiovasc Diabetol 24, 282 (2025). https://doi.org/10.1186/s12933-025-02811-8
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