February 28, 2023

A conversation about pregnancy and women’s heart health

New research shows blood pressure patterns early in pregnancy can identify the risk of later pregnancy-related high blood pressure conditions.

Doctors can use information about pregnancy-related complications to assess your overall risk of future cardiovascular disease and help you take steps to reduce that risk.

Heart disease is the leading cause of death for women in the United States. One of the leading risk factors for heart disease — high blood pressure — usually has no symptoms, so many women don’t know they have it. And sometimes, it can develop during pregnancy, putting both mother and child at risk.

Erica Gunderson, PhD, a Kaiser Permanente senior research scientist and epidemiologist, is bringing awareness to how pregnancy may affect women’s heart health.

Gunderson’s research showed that blood pressure patterns seen during the first 20 weeks of pregnancy can identify patients who are most likely to develop high blood pressure complications — known as preeclampsia and pregnancy-related hypertension later in their pregnancies. Preeclampsia, which is often signaled by high blood pressure and too much protein in urine, can affect other organs such as the kidney and liver.

Gunderson discusses her research and how women can use this information to better understand their risk of heart disease.

Which heart disease risk factors should women watch for?

Although there are many risk factors — such as high blood pressure, diabetes, obesity, smoking, and lifestyle behaviors — that men and women share, unhealthy pregnancy outcomes such as pregnancy-related hypertension and preeclampsia are unique to women.

In my recent study, we found that blood pressure measurements taken in the first half of pregnancy can identify patterns that signal a higher risk of developing hypertensive disorders during pregnancy beyond clinical factors, such as a first birth and high body weight. If doctors are aware of these patterns they may be able to identify these higher-risk patients earlier, and may be able to help them avoid pregnancy complications from hypertension.

Hypertension during pregnancy can have implications for women’s heart health beyond pregnancy, too. Previous studies have shown that women who experienced complications related to high blood pressure during pregnancy have an increased risk for developing cardiovascular disease later in life.

What did your research find about racial disparities among pregnant women with high blood pressure?

Research shows that Black and Hispanic women are most likely to experience heart disease. Black women are also significantly more likely to have high blood pressure before pregnancy and develop high blood pressure during pregnancy.

Consistent with previous research, my study of women who did not have high blood pressure before they became pregnant found that being Black or Hispanic was associated with a higher risk of developing hypertensive disorders during pregnancy. Other factors that increased risk during pregnancy were being younger, overweight, or obese before pregnancy, or not giving birth before.

Researchers are still working to understand the reasons why Black and Hispanic women have a higher risk of hypertensive disorders during pregnancy. Higher rates of hypertension before pregnancy, having more elevated blood pressure patterns during early pregnancy, and social drivers of health such as socioeconomic status and access to healthy food and health care, may play a role.

What can women do to better understand their risk for heart disease?

It’s important to know your individual risk factors for heart disease — such as your own medical history and family history of diabetes, high blood pressure, or heart disease, as well as lifestyle factors such as diet, physical activity, and sleep habits.

Our research shows there’s also value in talking to your primary care physician about risk factors before pregnancy, and about any pregnancy-related complications you may have experienced. Doctors can use that information to assess your overall risk of future cardiovascular disease and help high-risk patients take steps to reduce that risk.

Finally, continue to see your primary care physician regularly and monitor your blood pressure consistently if recommended by your doctor.

Learn about ways you can reduce your risk for heart attack and stroke.

AHA Honors Dr. Gunderson

Erica Gunderson, PhD, was honored with the American Heart Association’s 2022 Research Goes Red Award for best scientific publication on cardiovascular disease and stroke in women. Her study is the largest and most diverse study of its kind, including close to 175,000 Kaiser Permanente patients in Northern California.