New mothers who experience high blood pressure during pregnancy may require more than lifestyle adjustments to safeguard their long-term cardiovascular health, according to a study published Tuesday in The Lancet Obstetrics, Gynaecology & Women’s Health. The research, the largest of its kind, found that while lifestyle programs yielded modest benefits, they did not significantly lower blood pressure within a year of childbirth, leaving women vulnerable to ongoing risks of heart disease and related complications.
The Australian study, funded by NSW Health and led by Professor Amanda Henry of The George Institute for Global Health and Professor Mark Brown from St George Hospital, involved 525 women who had experienced hypertensive disorders of pregnancy (HDP). These disorders affect approximately 5-10% of pregnancies in Australia. Participants were assigned to receive either standard care, a single specialized postpartum clinic visit for education and counseling, or standard care combined with a six-month phone-based lifestyle program delivered through the clinic.
While approximately half of the women in the intervention groups demonstrated improvements in weight or waist size compared to 38% in the standard care group, their blood pressure levels remained largely unchanged six to twelve months after giving birth. Approximately 60% of women still exhibited at least two cardiovascular risk factors one year postpartum, and roughly one in five were taking medication to manage blood pressure at the six-month mark. The six-month phone-based lifestyle program offered no additional benefit over the single educational visit, and measures of blood sugar and kidney function showed minimal change.
“New mothers are highly motivated to prioritize their health, but the demands of caring for a newborn, fatigue, and returning to work can make substantial lifestyle changes tough,” said Professor Henry, Program Head of Women’s Health at The George Institute for Global Health. “While structured programs did help some women achieve health improvements like weight loss, most saw little change in their blood pressure, leaving them at continued risk. This underscores the need for postpartum care that integrates lifestyle support with medical monitoring and treatment, recognizing that women shouldn’t be expected to manage these risks independently.”
Hypertensive disorders of pregnancy, encompassing chronic hypertension, gestational hypertension, and preeclampsia, are significant contributors to maternal and infant illness, and mortality. These conditions elevate the risk of complications such as maternal kidney and liver injury, preterm birth, poor fetal growth, and stillbirth. Beyond the immediate pregnancy period, women who have experienced HDP face a substantially increased risk of developing chronic conditions like heart disease, kidney disease, and type 2 diabetes later in life. Research indicates that even a single episode of preeclampsia can increase a woman’s lifetime risk of heart disease two to fivefold, with the risk escalating for those experiencing preterm or chronic high blood pressure during pregnancy.
Despite these well-established risks, research on optimal postpartum support for women following a hypertensive pregnancy has been limited. Current guidelines for preventing heart disease are largely based on studies conducted on older, male populations and may not adequately address the specific needs and realities of new mothers.
Professor Henry emphasized the need for earlier postpartum follow-up, more frequent blood pressure monitoring, and the consideration of medication alongside lifestyle counseling to better protect women’s long-term cardiovascular health. “It’s clear that lifestyle advice, while essential, is not sufficient on its own,” she stated. “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 integrating structured cardiovascular screening and management into routine postnatal care, we have a real opportunity to improve outcomes and reduce the burden of heart disease for countless women starting or growing their families.”
The study, conducted between 2019 and 2023, involved screening 2,652 women and enrolling 525 participants, with 399 completing the 12-month follow-up. Participants were assigned to one of three groups six months after giving birth: standard care, a single education clinic visit, or a six-month phone-based lifestyle program. Researchers tracked changes in blood pressure, weight, and waist size, as well as other health indicators like diet, exercise, blood sugar, and kidney function.
