Your pregnancy was a stress test
If you had preeclampsia or gestational diabetes, that is information about the rest of your life.
This is the single most consequential thing the postpartum year contains, and the one most reliably not said.
ACOG's own words: Pregnancy is, therefore, a natural 'stress test' identifying at-risk women, but because these conditions often resolve postpartum, the increased cardiovascular disease risk is not consistently communicated to women. These adverse pregnancy outcomes are also not assessed when using current ASCVD risk assessment tools.
After gestational diabetes, there is a clear absolute number. Pooling 20 studies and 1.33 million people:
ACOG: All postpartum women with gestational diabetes should undergo glucose screening with a fasting plasma glucose test or a 75-g, 2-hour oral glucose tolerance test.
This guide could not find a repeat interval in ACOG's guidance. Ask your own clinician what current diabetes guidance recommends for follow-up screening, because the interval is set there and this guide could not verify it.
After preeclampsia, the picture is real but the numbers are harder to state honestly. Two large meta-analyses:
| Later outcome after preeclampsia | Relative risk | 95% CI |
|---|---|---|
| Heart failure | 4.19 | 2.09 to 8.38 |
| High blood pressure | 3.70 | 2.70 to 5.05 |
| Coronary heart disease | 2.50 | 1.43 to 4.37 |
| Death from cardiovascular disease | 2.21 | 1.83 to 2.66 |
| Stroke | 1.81 | 1.29 to 2.55 |
| Any cancer | 0.96 | 0.73 to 1.27, no increase |
So the honest version: for most women in their thirties the starting risk of heart disease is low, and a doubled or quadrupled risk of a low number is still a small number in the near term. What it changes is the long run. It means preeclampsia belongs on your cardiac record permanently, and it means the ordinary prevention advice starts applying to you earlier than it otherwise would.
The American Heart Association puts the practical point this way: A history of APOs is a prompt for more vigorous primordial prevention of CVD risk factors and primary prevention of CVD. Adopting a heart-healthy diet and increasing physical activity among women with APOs, starting in the postpartum setting and continuing across the life span, are important lifestyle interventions to decrease CVD risk.
Standard cardiac risk calculators do not ask. ACOG says so. Unless you tell them, it is not in the calculation.