Why High Blood Pressure During Pregnancy Increases Risk of Heart Disease

by Adrienne Mueller
November 13, 2025

Currently up to 10% of women experience high blood pressure during pregnancy – and this number is growing. Over the past two decades, the proportion of women with hypertension during pregnancy has increased 25%. The problem with this statistic is that what seem like temporary changes in blood pressure can have a lasting impact on women’s health. We know that women with persistently high blood pressure during pregnancy are more likely to suffer from heart disease later in life – but we don’t know why.

To better understand the mechanisms underlying the connection between hypertension during pregnancy and future heart disease, a team of investigators led by Mark Hlatky, Chi-Hung Shu, Nima Aghaeepour, and Virginia Winn conducted a study that was recently published in Hypertension. The investigators compared changes in biological pathways in women with hypertension during pregnancy and those without (normotensive) by assessing plasma protein levels at different time points relative to birth. They collected data at three different time points: during pregnancy but prior to birth (antepartum), soon after birth (postpartum), and an average of eight years after birth (mid-life).

The investigators found that – across all three time points - there were significant differences in protein levels between hypertensive and normotensive women. One of the most consistent changes was an increase in proteins related to coagulation and immune response. These changes were present at the time of birth, immediately after birth, and several years after birth. The changes in protein expression are so large, that it might be  possible to use the data to distinguish between women who did and did not have hypertension during pregnancy even years after delivery.

This is the first study to examine how protein expression associated with hypertensive pregnancies changes over time, which proteins return to normal and which do not. It clearly shows that hypertension during pregnancy causes changes in women’s protein expression that persist for years after birth. Moreover, this study shows the biological underpinnings of how early life events can have an impact on developing heart disease later in life. The consistent differences in coagulation and immune regulation pathways are evidence of biological mechanisms that might contribute to the increased future risk of heart disease. Further investigation of these pathways could lead to novel therapies to reduce cardiovascular disease in women.

Additional Stanford Cardiovascular Institute-affiliated investigators who contributed to this study include David K. Stevenson, Gary M. Shaw, Marcia L. Stefanick, Heather A. Boyd, Mads Melbye, Xi Du Plummer, Oshra Sedan, and Ronald J. Wong.