ArticleBMJ medicine2026
Pregnancy complications and risk of cardiometabolic-renal conditions in 1.4 million women in England: longitudinal study.
Article in BMJ medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To investigate the association between pregnancy complications and cardiometabolic-renal conditions (ie, cardiovascular disease, type 2 diabetes mellitus, hypertension, and chronic kidney disease) in the subsequent years after pregnancy. Design: Longitudinal study. Setting: Clinical Practice Research Datalink (CPRD) Aurum primary care database pregnancy register, UK, 1 January 2000 to 31 December 2022. Participants: 1 432 795 women, aged 15-49 years, who had been pregnant, with or without pregnancy complications, and registered with a general practitioner between 1 January 2000 and 31 December 2022. Main outcome measures: First recorded diagnosis of each of the four conditions: cardiovascular disease (ischaemic heart disease or cerebrovascular disease, including stroke and transient ischaemic attack), type 2 diabetes mellitus, hypertension, and chronic kidney disease (stages 3-5). Results: 1 422 287 participants were included in the cardiovascular disease outcome analysis, 1 389 460 in the hypertension, 1 411 883 in the type 2 diabetes mellitus, and 1 430 965 in the chronic kidney disease cohorts. Median follow-up was 4.1-4.3 years across the four cohorts (interquartile range approximately 1.5-9.8). Of 72 associations examined, 51 were significant after correction for multiple testing. Well established associations were found. Gestational hypertension and pre-eclampsia more than tripled the rate of hypertension and approximately doubled the rate of chronic kidney disease, with smaller increases for cardiovascular disease and type 2 diabetes mellitus. Gestational diabetes mellitus was associated with a sevenfold higher rate of type 2 diabetes mellitus and increased rates for hypertension and cardiovascular disease, but not for chronic kidney disease. Less well established associations were also found. Postnatal depression increased the rate of all four outcomes by 35-56% for the latest pregnancy (hypertension hazard ratio 1.36, 95% confidence interval (CI) 1.33 to 1.40; type 2 diabetes mellitus hazard ratio 1.41, 1.36 to 1.46; cardiovascular disease hazard ratio 1.56, 1.50 to 1.62; and chronic kidney disease hazard ratio 1.35, 1.25 to 1.45). Miscarriage, stillbirth, placental abruption, and preterm birth in the latest or in a previous pregnancy were associated with modestly higher rates of one or more outcomes (eg, stillbirth in the latest pregnancy: type 2 diabetes mellitus hazard ratio 1.67, 95% CI 1.33 to 2.08 and chronic kidney disease hazard ratio 1.79, 1.19-2.70; placental abruption in the latest pregnancy: chronic kidney disease hazard ratio 1.67, 1.06 to 2.62). Small-for-gestational-age birth was associated with higher rates of hypertension and cardiovascular disease, and large-for-gestational-age birth with higher rates for type 2 diabetes mellitus, including without gestational diabetes mellitus. Conclusions: Several pregnancy complications, including those occurring in previous pregnancies, were associated with an increased risk of cardiometabolic-renal conditions in the subsequent years after pregnancy. These findings support obtaining a full reproductive history and using the postpartum period as an opportune time for risk assessment and preventive cardioprotective strategies in women with a history of adverse pregnancy outcomes.
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