High Blood Pressure in Pregnancy: Lifestyle Changes Not Enough for Long-Term Heart Health

Women who have experienced high blood pressure during pregnancy may face ongoing cardiovascular risks that aren’t adequately addressed by lifestyle changes alone, according to a new study published in The Lancet Obstetrics, Gynaecology & Women’s Health. The research, the largest of its kind, suggests that a more proactive approach—including medical monitoring and potential medication—is needed to protect the long-term heart health of this vulnerable population.

The study, conducted in Australia, enrolled 525 women who had experienced hypertensive disorders of pregnancy (HDP), a condition affecting 5-10% of pregnancies in the country. Participants were followed for a year after giving birth and assigned to one of three groups: standard care, a single postpartum clinic visit for education and counseling, or standard care plus a six-month phone-based lifestyle program. While the lifestyle interventions led to modest improvements in weight and waist size for some women, they did not significantly lower blood pressure levels.

Approximately 60% of the women still had at least two cardiovascular risk factors one year after giving birth, and roughly one in five were taking blood pressure medication at six months. The six-month phone-based lifestyle program offered no additional benefit over a single educational visit, and measures like blood sugar and kidney function showed little change across the groups.

The Limitations of Lifestyle Interventions

“New mothers are highly motivated to look after their health, but the demands of caring for a newborn, fatigue, and returning to work can all make major lifestyle changes challenging,” explains Professor Amanda Henry, Program Head of Women’s Health at The George Institute for Global Health, and lead author of the study. “While structured programs did help some women achieve important health improvements like weight loss, most saw little change in their blood pressure, leaving them at ongoing risk. This highlights the need for postpartum care that combines lifestyle support with medical monitoring and treatment, recognizing that women shouldn’t be expected to manage these risks alone.”

Hypertensive disorders of pregnancy—including chronic hypertension, gestational hypertension, and preeclampsia—are significant contributors to maternal illness and death, and also increase the risk of complications for the baby, such as preterm birth and poor fetal growth. Beyond the immediate risks during pregnancy, HDP significantly elevates a woman’s long-term risk of developing chronic conditions like heart disease, kidney disease, and type 2 diabetes.

The danger is substantial: even a single episode of preeclampsia can increase a woman’s lifetime risk of heart disease two to fivefold, with the risk increasing further for those experiencing preterm or chronic high blood pressure during pregnancy. Despite these well-established risks, research on optimal postpartum support for women who have had HDP has been limited.

A Call for Proactive Postpartum Care

Current guidelines for preventing heart disease are often based on studies conducted in older, male populations, and may not adequately address the unique needs and challenges faced by new mothers. Professor Henry emphasizes the need for earlier postpartum follow-up, more frequent blood pressure monitoring, and consideration of medication alongside lifestyle counseling.

“It’s clear that lifestyle advice, while essential, is not enough on its own,” she states. “We urgently need a more proactive, structured approach, including preventive medications for those at highest risk, to protect women from the long-term heart risks after a hypertensive pregnancy. By bringing structured cardiovascular screening and management into routine postnatal care, we have a real chance to change outcomes and reduce the burden of heart disease for countless women starting or growing their families.”

Study Details

The study, conducted between 2019 and 2023, involved screening 2,652 women and ultimately enrolling 525 participants. Researchers followed the women for 12 months after childbirth, measuring changes in blood pressure, weight, waist size, and other health indicators. The randomized controlled trial aimed to determine whether structured follow-up and tailored lifestyle programs could improve cardiovascular health in this high-risk group.

The findings underscore the importance of recognizing hypertensive pregnancy as a significant cardiovascular risk factor and implementing comprehensive, individualized postpartum care plans. While lifestyle interventions play a role, they are often insufficient on their own, and a more proactive approach involving medical monitoring and potential medication is crucial for protecting the long-term heart health of women who have experienced HDP.

As Professor Henry notes, a shift towards more structured cardiovascular screening and management within routine postnatal care could significantly improve outcomes and reduce the long-term health burden for women after a hypertensive pregnancy.