- A large US study suggests that older age by itself may not be the main driver of cardiovascular complications in pregnancy.
- Instead, pregnancy seems to amplify a person’s existing cardiovascular risk, whatever their age.
- The findings strengthen the case for taking blood pressure, cholesterol and wider heart health seriously before and during pregnancy, not just in older mothers.
A large study from Weill Cornell suggests that pregnancy does not become riskier simply because someone is older.
Instead, the evidence points to a different explanation – pregnancy acts like a stress test that magnifies whatever cardiovascular risk is already there.
Researchers analysed hospitalisation data from more than 2.7 million people with a first pregnancy across 11 US states.
Each patient served as their own control, with cardiovascular events during pregnancy and the postpartum period compared against an equivalent time one year later.
Overall, pregnancy and the postpartum period were associated with about seven times the risk of major adverse cardiovascular events compared with the control period.
That fits with earlier research.
But the key point is what happened when the team looked at age.
The relative increase in risk compared with baseline did not vary with maternal age.
Older patients did have more cardiovascular events overall.
But the researchers say that reflects higher baseline cardiovascular risk, not an age-specific effect of pregnancy itself.
The most common complications were venous thromboembolism, cardiomyopathy and heart failure.
Stroke and brain haemorrhage were less common, but when they happened they were often devastating.
The study also found racial inequality.
Black patients were more likely to experience cardiovascular events than white patients, but again the age pattern did not explain this.
- Smoking in pregnancy may raise later metabolic risk when paired with a poor diet
- COVID-19 infection in pregnancy may pose risk to fetal brain development
- Inflammatory diet during pregnancy linked to increased risk of type 1 diabetes in children
That points towards other factors such as access to care, social determinants of health and differences in how risk factors are identified and managed.
The practical implication is fairly blunt.
Doctors should not assume that youth is protective and age is the only thing worth worrying about.
A healthy 40-year-old may carry less pregnancy-related cardiovascular risk than a 25-year-old with poorly controlled blood pressure, high cholesterol or other underlying issues.
That shifts the focus towards prevention.
