Issue 180  /  October 9, 2026  /  Feature

Pregnancy Already Screens Women for Heart Disease

A study of 1.4 million women in England finds that pregnancy complications flag cardiometabolic and kidney risk years after birth. The payment system still treats them as maternity events.

Pregnancy Already Screens Women for Heart Disease

On October 6, BMJ Medicine published a study of 1,432,795 women in England who had been pregnant between 2000 and 2022.

Steven Wambua and colleagues at the University of Birmingham and King's College London, working within the national MuM-PreDiCT consortium, linked primary care records from the Clinical Practice Research Datalink Aurum database to hospital data.

They tested ten pregnancy complications against the first diagnosis of four conditions: cardiovascular disease, type 2 diabetes, hypertension and chronic kidney disease.

Of 72 associations tested, 51 held up after a standard statistical check for chance findings.

That complicated pregnancies carry later risk is not new. What the study adds is how many complications carry it, and how long after birth it shows up.

A complicated pregnancy can warn of heart, metabolic or kidney disease years before it is diagnosed. The health system still pays for that warning as maternity care.

Follow-up started about six months after each woman's most recent birth and ran a median of roughly four years.

In that window, 3.5% of the hypertension cohort (49,233 of 1,389,460 women) were diagnosed with hypertension, and 1.1% of the cardiovascular cohort (16,069 of 1,422,287) developed cardiovascular disease. The authors are clear that the study predicts risk but does not prove cause. A complication is a warning sign, not evidence that the complication itself led to the disease.

The known associations held. Gestational diabetes in the most recent pregnancy came with about seven times the rate of type 2 diabetes. Preeclampsia came with about 4.5 times the rate of hypertension, and gestational hypertension with more than twice the rate of chronic kidney disease.

England already tells doctors to follow up on these, and it shows in the data. Women who had them got their blood pressure and glucose checked more often.

The less familiar findings matter more for companies. Postnatal depression after the most recent pregnancy was linked to a 56% higher rate of cardiovascular disease, a 41% higher rate of type 2 diabetes, a 36% higher rate of hypertension and a 35% higher rate of chronic kidney disease, compared with women with no history of it. Postnatal depression in an earlier pregnancy still carried a 43% higher cardiovascular rate.

The models adjusted for age, body mass index, smoking, deprivation, alcohol misuse and other established risk factors. They could not adjust for diet or physical activity, which UK primary care records capture poorly, and ethnicity was missing for more than a fifth of the cohort.

Women with postnatal depression also had their blood pressure and glucose checked more often, so some extra diagnoses may simply reflect more testing. The authors cannot say how much. Women who are developing hypertension or diabetes also tend to see their doctor more in the months before diagnosis, which produces the same pattern.

The authors call for postpartum care that brings mental health services together with primary care, cardiology, nephrology and endocrinology. Today those usually sit with different clinicians.

That makes a postnatal depression screen worth more than it looks. A company running one is already collecting a cardiovascular risk marker, and the authors note it is missing from QRISK3 and QDiabetes, the risk tools UK clinicians use.

Earlier pregnancies counted too. Preeclampsia in a previous pregnancy came with almost three times the rate of hypertension. The authors say their design likely understates these links, because higher-risk women diagnosed before their latest pregnancy were left out of the analysis.

Doctors usually assess postpartum risk based on the most recent pregnancy alone. The study says the whole pregnancy history matters. Megha Singh, a Birmingham research fellow and co-author, said in the university's release that once a woman leaves maternity care, this information is "too often lost."

The study comes from England, which has one national payer.

In the US, the years the study tracks can fall under several insurers. Medicaid pays for about 4 in 10 US births, according to KFF. Federal law requires pregnancy-related Medicaid coverage through 60 days postpartum, and states have a permanent option to extend it to 12 months. After that, some women qualify through another pathway and others lose coverage. The study's window opens six months after birth and runs about four years, so most of the risk it measures arrives after even extended postpartum coverage has ended. The insurer that pays for the birth may not be the one that pays for the diagnosis.

A coding change on January 1 makes this concrete. The AMA's CPT code set deletes the global maternity packages, and outpatient postpartum visits will be billed one at a time with standard evaluation and management codes, including telemedicine and virtual check-in codes. CPT sets how care is reported, not whether a plan pays for it, so coverage still depends on each payer.

So a postpartum visit becomes its own billable appointment. The code pays for the appointment. It does not pay anyone to make sure what was learned there reaches the doctor who sees her four years later.

The study has a clear limit. It shows that pregnancy history predicts disease. It does not test whether acting on that history prevents any. The authors call for testing whether adding pregnancy history to existing risk models makes them more accurate, and that is the evidence a payer would want before paying for a product built on it.

A product built on these findings would not be a maternity product. It would take a woman's pregnancy history and flag her risk of heart, metabolic and kidney disease. Its buyer is whoever will be paying for her care when that disease arrives.

For cardiovascular disease, postnatal depression carried almost the same added risk as preeclampsia, a 56% higher rate against 57%.

Only one of them comes with guidelines for heart follow-up.

This article is for informational purposes and is not medical advice.

---

Sources

Primary

— Keisha, Editor of The Luteal