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From Stroke to Diabetes, Past Pregnancies Can Take Their Toll Later in Life
Pregnancy and childbirth may be a distant memory, but complications from years ago can offer important clues about your health after 50
8-minute read
An elderly woman takes her blood pressure at home. Unrecognizable person, hand close-up.
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Key takeaways
- Pregnancy complications can point to higher risks of heart disease, stroke, diabetes and other health problems later in life.
- High blood pressure during pregnancy is linked to later cardiovascular conditions, while gestational diabetes raises the risk of type 2 diabetes.
- Tell your doctor about past pregnancy complications so they can consider earlier prevention, screening and treatment.
Like most middle-aged women, Tina Harris never gave a thought to the health issues she’d had in her four pregnancies. And once she passed her childbearing years, no doctor ever asked about them. “I put that behind me,” says Harris, 63. “I didn’t think there would be problems later on in life.”
But at the age of 50, her past came hurtling back in a shocking way. She got up in the night to go to the bathroom and collapsed on the floor. She tried to call out for help but couldn’t speak. She tried to move, but her right side was paralyzed. She later learned she’d had an ischemic stroke, caused by a blockage of blood flow in the brain.
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When she was in rehab, relearning to walk and talk, a doctor asked if she’d had any problems with her pregnancies. That was how she found out that complications in pregnancy and childbirth can leave long-term health risks. In her first pregnancy, she developed high blood pressure that didn’t go away after her daughter was born.
She later started taking medicine to lower her blood pressure, but in her next three pregnancies, she had preeclampsia, a serious condition that involves persistently high blood pressure and other symptoms.
Since her stroke, Harris has worked hard to regain her speech and mobility — and her therapy continues. She also enrolls in research studies at the University of Pittsburgh, near her home, to support her recovery — and hopefully to help others, too.
She’d like other women to know about the lifelong risks that pregnancy can reveal. “If you don’t know to ask questions or if you don’t know what could happen, you can’t prevent it from happening,” says Harris, who also has a family history of high blood pressure.
What to tell your doctor
Different types of pregnancy complications are linked to later development of heart disease, stroke, diabetes and other health conditions. Risks rise for women who had diabetes or high blood pressure that started during pregnancy, and for those who had a preterm birth, a baby with low or high birth weight, a placenta abruption, or stillbirth or miscarriage.
It’s not entirely clear why those pregnancy events foreshadow later health problems. Pregnancy could reveal an underlying vulnerability, or pregnancy complications themselves might cause lasting effects, says Stefanie Hinkle, an epidemiologist at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
Either way, pregnancy is an important part of a woman’s medical history, no matter her age. “These complications can identify women who may benefit from earlier prevention and lifelong care,” she says. Hinkle studied lifelong pregnancy effects in more than 46,000 U.S. women who gave birth between 1959 and 1966 by linking their health information to national death records through 2016. Five decades after childbirth, women with pregnancy complications had a higher risk of death. She even found increased mortality among women who gained more than the recommended amount of weight during pregnancy or who didn’t return to their prepregnancy weight.
Childbirth can also leave lifelong physical consequences. Damage from vaginal tears during a difficult delivery can cause problems later in life, such as weakening of pelvic organs and tissues and bladder or bowel incontinence.
Here’s what the latest research says about the long-term effects of pregnancy complications and steps you can take to address them.
Stroke and vascular dementia
When Dr. Eliza Miller meets a new patient in her women’s stroke clinic at the University of Pittsburgh Medical Center (UPMC) Magee-Women’s Hospital, she wants to know the details about their long-ago pregnancies. Medical trainees shadowing her often wonder why she poses these questions to older women. “I’m asking because it’s highly relevant to this woman’s brain health,” responds Miller, a vascular neurologist who leads one of the nation’s only divisions of women’s neurology.
Her patients might be surprised, too; often, no other doctor has asked about their pregnancies since they left their postpartum years. “I hope that is changing now with increasing recognition of this issue,” Miller says.
In 2011, the American Heart Association (AHA) updated its guidelines for preventing cardiovascular disease in women and included advice to clinicians to “take a careful and detailed history of pregnancy complications.…” Ten years later, in a scientific statement, the association outlined evidence linking certain health problems during pregnancy to later cardiovascular disease.
Miller’s own research adds to that. She analyzed lifetime health records of 144,306 Finnish women who had at least one birth from 1969 or later. Women with at least one pregnancy complication had a higher risk of stroke, and they were more likely to have a stroke at a younger age.
Similarly, there’s an increased risk of vascular dementia, a form of dementia caused by reduced blood flow to the brain, such as from persistent high blood pressure and stiffening of arteries. Miller found the connection between vascular dementia and pregnancy complications by combining data from more than 6 million patients across 11 studies; her analysis, known as a systematic review and meta-analysis, was published in The Lancet Healthy Longevity in 2024.
The good news: Heart-healthy habits can reduce the risk. The AHA calls them Life’s Essential 8: keeping blood pressure, cholesterol, blood sugar and weight in the optimal range, getting two and a half hours of exercise per week, eating a healthy diet and quitting smoking. Getting enough sleep, an “essential” that is often overlooked, is important for brain health, Miller says. The AHA recommends seven to nine hours.
It can be hard to achieve all of those benchmarks. “We try to just do what we can to reduce the risk,” Miller tells her patients.
Heart disease and diabetes
Dr. Nisha Parikh, a cardiologist who specializes in women’s heart disease, is committed to spreading the word about future risks linked to pregnancy complications. She chaired the American Heart Association committee that wrote the 2021 scientific statement on the risk of “adverse pregnancy outcomes,” or complications such as preeclampsia, high blood pressure or diabetes that arise during pregnancy and preterm birth.
“If you’re a postmenopausal woman and you think you’ve had one of these adverse pregnancy outcomes, our recommendation is to let your primary care doctor know, let your cardiologist know,” says Parikh, director of cardiovascular medicine at the Katz Institute for Women’s Health at Northwell Health in New Hyde Park, New York. The pregnancy problems “might signal to a doctor to be more aggressive with lipid-lowering, with hypertension management and with lifestyle counseling to prevent cardiovascular disease.”
Pregnancy complications count as “risk enhancers” in a predictive tool doctors use to estimate a patient’s likelihood of developing cardiovascular disease within the next 10 years. Blood pressure disorders during pregnancy, such as gestational hypertension or preeclampsia, have a strong link to later cardiovascular conditions.
The Women’s Health Initiative followed about 162,000 postmenopausal women from the mid-1990s to 2005. Parikh later collaborated with a group of researchers to survey about 10,300 of those participants about their past pregnancies. Women who had hypertensive disorders during pregnancy were 75 percent more likely to have heart failure later in life.
In a separate study of about 48,000 participants, women who had hypertensive disorders during pregnancy were 27 percent more likely to develop atherosclerotic cardiovascular disease, which is plaque buildup or narrowing of arteries that leads to heart attack, stroke or poor circulation in the arms and legs.
When Parikh talks to patients about a heart-healthy lifestyle, she emphasizes eating at least seven servings of fruits and vegetables each day. “There’s potassium in fruits and vegetables,” she says. “That’s a natural blood-pressure-lowering substance.”
Meanwhile, the later-in-life risk of having type 2 diabetes is almost 10 times higher among women who had gestational diabetes, or diabetes that starts during pregnancy. Gestational diabetes usually goes away after delivery, but the American Diabetes Association recommends following up with lifelong screening for diabetes every one to three years.
Pelvic prolapse and dysfunction
As women age, they might not recognize the lingering impact of a difficult childbirth. Or they might not know how to talk about it.
“Women often struggle with trying to come up with words,” says Dr. John O. L. DeLancey, a urogynecologist at the University of Michigan Medical School in Ann Arbor who did pioneering research on pelvic organ prolapse and other birth-related injuries. “It’s a feeling that there’s abnormal pressure, that they can feel that things are kind of coming out.”
With pelvic organ prolapse, injured muscles weaken over time, causing the vagina and uterus to protrude. Weak muscles from a long-ago childbirth injury might also cause urine to leak when coughing, sneezing, laughing or during exercise. Pelvic floor disorders can also lead to bowel incontinence or sexual dysfunction.
Some women get relief from a pessary, which resembles a diaphragm used for birth control. “It fits in the vagina, and it holds things in place,” DeLancey says. Pelvic floor physical therapy can strengthen and train the muscles.
About 1 in 10 women who give birth vaginally eventually have pelvic floor surgery, he says. There are different approaches to the surgery, but a common goal: “They won’t feel the pressure anymore. There won’t be a bulge coming out. They’ll feel more like themselves again,” says DeLancey.
The key takeaways were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.
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