Your Pregnancy Was a Stress Test: 7 Questions to Ask Before It's Too Late
Preeclampsia, gestational diabetes, and preterm birth aren't just pregnancy problems. They are warnings.
Maria was 52 when she had her first heart attack.
She had no family history of heart disease. She didn’t smoke. Her cholesterol was borderline. By every standard screening tool, she was low risk.
But Maria had preeclampsia with her first baby at 29. She had gestational diabetes with her second at 32. Nobody ever told her those pregnancies were trying to tell her something.
Her cardiologist didn’t ask about her pregnancy history. Her gynecologist stopped seeing her years ago. And the most powerful predictor of her heart attack was buried in a medical chart from two decades earlier.
Maria’s story isn’t unusual. It’s the norm.
Your body already ran the test. Did anyone read the results?
Pregnancy does something no treadmill stress test can replicate. Over nine months, your body increases blood volume by nearly 50%. Your cardiac output rises dramatically. Your pancreas must produce significantly more insulin. Your kidneys filter at overdrive capacity. Your blood vessels must dilate and accommodate an entirely new circulatory system.
This is the most comprehensive cardiovascular and metabolic stress test you will ever take. And you took it for free, in your 20s or 30s, decades before a cardiologist would think to screen you.
When something goes wrong during this stress test, it reveals vulnerabilities. Preeclampsia exposes blood vessel dysfunction. Gestational diabetes unmasks insulin resistance. Preterm birth signals inflammatory and vascular problems that don’t disappear at delivery.
The International Federation of Gynecology and Obstetrics (FIGO) recognized this in 2023 when they created the Pregnancy Passport, a document designed to track pregnancy complications as long-term health risk factors. The idea is simple: what happened during your pregnancy should follow you for life.
But most women never get this passport. Most women never get a conversation about it at all.
The numbers your doctor should have shared
The data is not subtle. It’s not ambiguous. It’s not emerging. It’s established.
Women who had preeclampsia face a 4-fold increased risk of heart failure and a 2-fold increased risk of coronary heart disease, stroke, and cardiovascular death. These numbers hold up even after adjusting for age, BMI, and diabetes.
Women who had gestational diabetes carry up to a 10-fold increased risk of developing type 2 diabetes. A meta-analysis of over 170,000 women estimated the risk of type 2 diabetes at roughly 20% by 10 years, 30% by 20 years, and nearly 60% over a lifetime.
Women who delivered preterm have double the risk of future cardiovascular disease.
And perhaps most striking: a 2024 systematic review in the American Journal of Obstetrics and Gynecology found that women with a history of preeclampsia have nearly twice the risk of vascular dementia (adjusted HR 1.89). For women over 65, preeclampsia was associated with close to double the risk of Alzheimer’s disease.
These aren’t rare outcomes. Approximately 20% of all U.S. pregnancies involve at least one complication. That’s one in five women walking around with critical health information locked in an old obstetric chart that nobody is reading.
