Scientists found that women who had postpartum depression developed heart disease and stroke at a 56% higher rate, and standard risk calculators leave it out
After a baby arrives, doctors watch closely for a few pregnancy problems that are known to signal heart trouble later, mainly pre-eclampsia and gestational diabetes. Postpartum depression is not on that list. UK researchers have now gone through the medical records of 1.4 million women in England who had been pregnant, checking ten different pregnancy complications against four conditions that tend to arrive together: heart disease and stroke, type 2 diabetes, high blood pressure, and chronic kidney disease. One complication that doctors do not usually connect to heart health stood out.
How the records were used
The team used CPRD Aurum, a database of anonymized records from general practices across England, linked to hospital data. They included women aged 15 to 49 who were pregnant at some point between 2000 and 2022. Follow-up started about six months after the birth of each woman’s most recent baby, so the normal changes of pregnancy had time to settle. Women were followed for a median of about four years.
The researchers recorded whether each complication happened in the most recent pregnancy or in an earlier one. They adjusted for the risk factors doctors already use, including age, ethnic group, deprivation, blood pressure, body mass index, smoking, alcohol misuse, family history of heart disease, migraine, and several chronic conditions and medications.
For context on the starting risk: over the follow-up period, 3.5% of all women developed high blood pressure, 1.5% type 2 diabetes, 1.1% heart disease or stroke, and 0.4% chronic kidney disease. These were mostly women in their thirties, so the absolute numbers are small.
What postpartum depression was linked to
Postpartum depression after the most recent pregnancy was linked to higher rates of all four conditions. The rate of heart disease and stroke was 56% higher than in women with no history of it. Type 2 diabetes was 41% higher, high blood pressure 36% higher, and chronic kidney disease 35% higher.
The link did not disappear when the depression had happened in an earlier pregnancy. Women who had postpartum depression after a previous baby still had a 43% higher rate of heart disease and stroke, and higher rates of the other three conditions as well.
The authors suggest possible explanations. Postpartum depression often involves chronic inflammation and a stress hormone system stuck in overdrive, with raised cortisol and insulin resistance. Depression can also change eating, sleep and activity in ways that strain the heart and metabolism over time.
The complications doctors already watch
The well-known warning signs held up strongly. Gestational hypertension and pre-eclampsia in the most recent pregnancy were linked to roughly four times the rate of later high blood pressure, and about double the rate of chronic kidney disease. Gestational diabetes was linked to a sevenfold higher rate of type 2 diabetes.
Several less familiar complications also carried a signal. Stillbirth in the most recent pregnancy was linked to higher rates of type 2 diabetes and kidney disease, placental abruption to higher rates of kidney disease, and preterm birth to higher rates of heart disease and diabetes. Miscarriage showed smaller links with some outcomes. Of 72 combinations the team tested, 51 remained significant after correcting for the number of tests.
Complications in earlier pregnancies mattered too. Women whose pre-eclampsia happened in an earlier pregnancy, rather than the most recent one, still had nearly three times the rate of later high blood pressure. That matters because doctors usually assess risk based on the most recent birth.
What earlier studies found
The pre-eclampsia and gestational diabetes findings match long-standing evidence. A 2007 analysis in The BMJ pooled studies of more than three million women and found that pre-eclampsia was linked to a much higher risk of later high blood pressure and heart disease. A 2009 analysis in The Lancet found that women with gestational diabetes were about seven times more likely to develop type 2 diabetes, almost exactly the figure in the new study.
For postpartum depression, the evidence is thinner. The authors note that a handful of earlier studies reported higher rates of heart disease, high blood pressure and kidney disease after it, but most looked at a single pregnancy and adjusted for fewer risk factors. The new study is far larger and covers all four conditions at once.
What the study cannot show
This is an observational study, and the authors stress that it identifies warning signs, not causes. Postpartum depression may not damage the heart directly. It may instead mark women who already carry a higher underlying risk.
Detection could also play a part. Women who had pregnancy complications saw their doctors more often and had their blood pressure and blood sugar checked more, which makes a diagnosis more likely. For women with postpartum depression, that extra monitoring persisted even after excluding other complications. The authors note that it could equally reflect early symptoms of the disease itself.
The records had no reliable data on diet or physical activity, and ethnicity was missing for more than a fifth of women. Early miscarriages are often never recorded. And with a median follow-up of about four years, the study shows risk in the years soon after pregnancy, not across a lifetime.
Why risk calculators may need updating
The tools UK doctors use to estimate heart and diabetes risk, QRISK3 and QDiabetes, do not include postpartum depression or placental abruption. The authors argue that taking a full pregnancy history, including earlier pregnancies, could help spot women who would benefit from earlier blood pressure, blood sugar and kidney checks, along with mental health support. This week we also reported on another overlooked piece of women’s heart health, how the form of menopause hormone therapy relates to blood clot risk.
The study was funded by the Medical Research Council, the National Institute for Health and Care Research, the British Heart Foundation Data Science Centre, and the HDR UK-Turing Wellcome PhD programme.
Source
Wambua S, Singh M, Rishard M, et al. “Pregnancy complications and risk of cardiometabolic-renal conditions in 1.4 million women in England: longitudinal study.” BMJ Medicine, 2026.
DOI: 10.1136/bmjmed-2026-003035
Also cited
Bellamy L, Casas JP, Hingorani AD, Williams DJ. “Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis.” The BMJ, 2007.
DOI: 10.1136/bmj.39335.385301.BE
Bellamy L, Casas JP, Hingorani AD, Williams D. “Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis.” The Lancet, 2009.
DOI: 10.1016/S0140-6736(09)60731-5
