How pregnancy can help to identify heart disease risk

Manchester researchers are investigating how pregnancy and the postnatal period can be used to identify cardiovascular risk to help boost outcomes for women's long-term heart health.

Women who experience complications during pregnancy, particularly pre-eclampsia - a condition involving high blood pressure and problems with the placenta - face a significantly increased risk of developing cardiovascular disease later in life. Despite this, many women receive little long-term follow-up care once pregnancy ends.

Research led by Laura Ormesher is investigating how pregnancy and the postnatal period can be used to identify cardiovascular risk earlier and improve women's long-term heart health outcomes.

Pregnancy complications and future cardiovascular disease

Cardiovascular disease is one of the leading causes of death in women worldwide. Yet many women at increased risk are not identified until years after serious health problems begin to develop.

Research has shown that hypertensive disorders of pregnancy, particularly pre-eclampsia, can act as an early warning predictor of future cardiovascular disease. Women who experience preterm pre-eclampsia are three to eight times more likely to die from cardiovascular disease later in life compared to women who had an uncomplicated pregnancy.

Despite the known long-term risks, many women receive little cardiovascular follow-up care once pregnancy ends. For many women, pregnancy is also the first time they regularly engage with healthcare services, creating an important opportunity for earlier intervention and prevention.

"Pregnancy gives us a window into future cardiovascular health and an opportunity to intervene much earlier," explains Laura. The research focuses on understanding how heart and blood vessel health changes following pregnancies complicated by pre-eclampsia and how healthcare systems can better support women during the postnatal period.

Understanding risk and improving postnatal care

During her PhD, Laura conducted a randomised clinical trial investigating whether a low-cost, widely available medication could improve cardiovascular health following preterm pre-eclampsia.

The study showed encouraging early results, demonstrating improvements in cardiovascular health after six months of treatment. Alongside this, the research identified that many cardiovascular and metabolic health problems were being missed through routine NHS care after pregnancy.

This research led to the creation of the Interpregnancy Study of Cardiometabolic Health (INSITE), a specialist postnatal cardiometabolic health clinic in Manchester for women who have experienced early pre-eclampsia. The clinic now forms part of routine clinical care, supporting women three to six months after pregnancy through cardiovascular monitoring and lifestyle advice, with onward referral to GP and other specialties as required for ongoing management.

Women who attend receive guidance about risk of future pregnancy complications, future cardiovascular disease and advice on preventative health measures. GPs are also informed about appropriate follow-up care and monitoring relating to the women.

Combining research with patient care

Alongside clinical care, INSITE also provides opportunities for women to take part in research aimed at improving future prevention and treatment strategies. This involves participating in a range of cardiovascular assessments including heart scans, blood vessel imaging, advanced blood pressure measurements and blood testing.

Researchers can then follow participants over several years to better understand which early changes are linked to future complications, such as recurrent pre-eclampsia, persistent high blood pressure and cardiovascular disease later in life.

"We want to understand which features in the early postnatal period relate to future risk," says Laura. "That helps us understand what we should be targeting."

Laura and colleagues have also worked closely with women who have experienced high blood pressure disorders during pregnancy to co-create information resources (infographics) and to seek feedback on the acceptability of postnatal cardiovascular testing, ensuring that research and care reflect women's real-life experiences and priorities.

Addressing inequalities in women's cardiovascular health

Cardiovascular disease in women remains under-recognised, under-treated and under-researched, particularly in relation to pregnancy complications. Many women leave maternity care without clear information about their future cardiovascular risk or access to long-term follow-up support.

This research aims to improve awareness of these risks earlier in life and ensure women who are at risk, are not lost within healthcare systems after pregnancy. The work could also support improvements in wider societal benefits as women often play a central role in a family's health and lifestyle decisions, meaning interventions that improve women's health may also positively influence wider family wellbeing.

While the research is rooted in the NHS and based in Manchester, the potential impact of this work is global. Hypertensive disorders of pregnancy affect women worldwide and remain a major contributor to maternal illness and death, particularly in lower-resource healthcare settings where access to long-term cardiovascular follow-up may be limited.

By demonstrating how pregnancy can be used as an opportunity for earlier cardiovascular prevention, the research could help inform future healthcare models internationally.

If successful, this work could support a shift towards earlier identification, prevention and personalised care for women at risk of cardiovascular disease - improving outcomes not only for mothers, but for families and future generations.