December 23, 2025
2 min read
Key takeaways:
- The incidence of CV-related pregnancy complications increased between 2001 and 2019.
- Complications occurred more frequently among individuals with greater cardiometabolic burden and preexisting CVD.
The burden of maternal cardiometabolic comorbidities and incident pregnancy-related CV complications has increased substantially over the past 20 years in the United States, according to recent research.
“We have seen a steady, decades-long rise in both baseline cardiovascular risk at conception and the downstream complication rates in a relatively young population. Women are entering pregnancy less healthy and, as a result, experiencing more cardiovascular complications,” Emily S. Lau, MD, MPH, co-director of the Mass General Brigham Women’s Heart Health Program and assistant professor at Harvard Medical School, told Healio.
Lau and colleagues aimed to better understand the burden of pregnancy-related CV complications and trends over time. The researchers analyzed 56,833 pregnancies among 38,996 individuals between 2001 and 2019 in a multi-institutional electronic health record-based pregnancy cohort. Mean age at start of pregnancy was 33 years. Race/ethnicity was 59% white, 13% Hispanic, 11% Black, 6% Asian and 11% other.
“Pregnancy is a natural ‘stress test’ for the heart. In the U.S., pregnancy-related cardiovascular complications are now the leading cause of maternal morbidity and mortality, and they’re rising. Yet the tools we use to identify risk early — especially in the first trimester — are blunt, costly or not widely available. We asked: Can we leverage information that’s already routine — a standard 12-lead ECG and the electronic health record — to flag women at higher risk before problems emerge? Specifically, we wanted to know whether cardiorespiratory fitness estimated from a resting ECG, a low-friction, scalable signal, tracks with subsequent pregnancy-related cardiovascular complications,” Lau told Healio.
Among this cohort, the overall prevalence of maternal CVD was 4% and the age-adjusted prevalence was 8%, according to the findings published in Circulation. Age-adjusted prevalence increased from 1% in 2001 to 7% in 2019 (P < .001).
The overall incidence of pregnancy-related CV complications, including maternal death, major adverse CV events and hypertensive disorders of pregnancy from the end of the first trimester to 1 year postpartum, was 15%; the age-adjusted incidence was 17%. Age-adjusted incidence also increased over the 19-year period, from 11% in 2001 to 13% in 2019 (P < .001), according to the results.
“Pregnancy-related cardiovascular complications were more frequently in the presence of maternal cardiometabolic comorbidities and prevalent CVD and among non-Hispanic Black women,” the researchers wrote in Circulation.
CV complications within 1 year postpartum were more likely to occur in those with cardiometabolic risk factors compared with those without (obesity: 20% vs. 11%; diabetes: 6% vs. 3%; hypertension: 23% vs. 5%; hyperlipidemia: 13% vs. 10%; CVD: 10% vs. 3%; P < .001 for all), according to the results.
“Together, our findings showcase an alarming trend of rising real-world burden of pregnancy-related cardiovascular complications,” the researchers wrote in Circulation.
Lau said the results “corroborate what we have seen consistently across all types of studies.
“Our study highlights the importance of considering pregnancy, from preconception to the postpartum period, as a pivotal period for cardiovascular risk screening and optimization. We need to develop more precise tools to better identify high-risk women to enable more coordinated care and preventive strategies,” Lau told Healio.
For more information:
Emily S. Lau, MD, MPH, can be reached at cardiology@healio.com.
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