Hypertensive Pregnancy Outcomes Linked to Decades-Long Risk of Atrial Fibrillation
A new study reveals that adverse pregnancy outcomes, particularly those involving high blood pressure, are associated with an increased risk of developing atrial fibrillation (AF) – an irregular heartbeat – up to 46 years later, underscoring the need for extended cardiac monitoring for women with a history of pregnancy complications.
Researchers have long suspected a connection between hypertensive disorders of pregnancy and later-life cardiovascular disease. However, previous investigations often lacked the long-term follow-up necessary to establish a definitive link, and few examined multiple pregnancy complications simultaneously. This new research aims to address those gaps, clarifying whether these associations reflect pre-existing risk factors, or whether adverse pregnancy outcomes themselves contribute to the development of AF.
To investigate, a team led by Casey Crump, MD, PhD, of the University of Texas Health Science Center, conducted a national cohort study analyzing data from over 2 million women in Sweden. “We hypothesized that women who experienced adverse pregnancy outcomes would have long-term increased risks of AF and that such risks would only be partially explained by shared familial factors,” explained Dr. Crump and colleagues.
The study identified six specific adverse pregnancy outcomes using records from the Swedish Medical Birth Register: preterm delivery (before 37 weeks of gestation), small for gestational age (low birth weight), large for gestational age (high birth weight), preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes. Diagnoses of AF were tracked through nationwide inpatient and outpatient records up to 2018.
The analysis included 2,201,047 women, with 39.3% – or 865,912 individuals – experiencing at least one of the adverse pregnancy outcomes. Large for gestational age was the most common (14.8%), followed by small for gestational age (14.3%) and preterm delivery (8.9%). Over 54 million person-years of follow-up, 51,173 women (2.3%) were diagnosed with AF. The median age at first delivery was 27 years, while the median age at AF diagnosis was 63 years.
The findings revealed that all adverse pregnancy outcomes, except being small for gestational age, were independently associated with an increased risk of AF over the course of the follow-up period. Specifically, the researchers calculated hazard ratios (HRs) to quantify the increased risk:
- Other hypertensive disorders: HR, 1.46 (95% CI, 1.34-1.58)
- Preeclampsia: HR, 1.36 (95% CI, 1.32-1.4)
- Large for gestational age: HR, 1.19 (95% CI, 1.16-1.22)
- Preterm delivery: HR, 1.14 (95% CI, 1.1-1.18)
- Gestational diabetes: HR, 1.12 (95% CI, 1.01-1.24)
- Small for gestational age: HR, 0.98 (95% CI, 0.95-1)
The risk was particularly elevated within the first decade after delivery. Women with hypertensive disorders had a 69% increased risk (HR, 1.69; 95% CI, 1.32-2.15), while those with preterm delivery or large for gestational age experienced a 46% (HR, 1.46; 95% CI, 1.26-1.7) and 16% (HR, 1.16; 95% CI, 1.01-1.32) increase, respectively. Even 30-46 years post-delivery, elevated risks persisted, with substantial increases observed for other hypertensive disorders (HR, 1.44; 95% CI, 1.24-1.66), preeclampsia (HR, 1.38; 95% CI, 1.33-1.5), gestational diabetes (HR, 1.19; 95% CI, 1.03-1.37), large for gestational age (HR, 1.17; 95% CI, 1.14-1.21), and preterm delivery (HR, 1.11; 95% CI, 1.07-1.16).
“The present study’s findings have important clinical implications,” the researchers concluded. They emphasize that preeclampsia, other hypertensive disorders of pregnancy, large for gestational age, gestational diabetes, and preterm delivery should all be recognized as long-term risk factors for AF. The team advocates for prioritizing high-quality preconception and prenatal care to reduce the incidence of these adverse outcomes and mitigate their long-term cardiovascular consequences.
This research underscores the importance of considering pregnancy history as part of a comprehensive cardiovascular risk assessment for women, potentially leading to earlier interventions and improved long-term health outcomes.
Reference: Crump C, Wei J, Sundquist J, Sundquist K. Adverse pregnancy outcomes and long-term risk of atrial fibrillation. JAMA Cardiology. Published online October 22, 2025. doi:10.1001/jamacardio.2025.3951
Al Bahhawi T, Aqeeli A, Harrison SL, et al. Pregnancy-Related Complications and Incidence of Atrial Fibrillation: A Systematic Review. J Clin Med. 2023;12(4):1316. Published 2023 Feb 7. doi:10.3390/jcm12041316
