December 2025
Women with adverse pregnancy outcomes may be at increased atrial fibrillation risk
By Rebecca Jenkins
Women who experience pre-eclampsia, gestational diabetes and certain other pregnancy complications have a long-term increased risk of atrial fibrillation (AF), a large study finds.
It was known that women who had adverse pregnancy outcomes were at higher risk of developing cardiovascular disease (CVD), but their long-term risk of AF was unclear, researchers wrote in JAMA Cardiology.
To address this knowledge gap, the researchers used data from Swedish health registries to analyse the association between long-term risk of AF and preterm delivery, small for gestational age delivery, large for gestational age delivery, pre-eclampsia, other hypertensive disorders and gestational diabetes.
Of the 2,201,047 women with 54 million person-years of follow up included in the study, 51,173 (2.3%) had an AF diagnosis.
During the entire follow-up period (up to 46 years after delivery) all the included adverse pregnancy outcomes except for small for gestational age delivery were independently associated with a long-term increased risk of AF.
Within 10 years of delivery, the adjusted hazard ratios (HRs) only showed an increased risk of AF among women with hypertensive disorders other than pre-eclampsia (HR, 1.69), preterm delivery (HR, 1.46) or large for gestational age delivery (HR, 1.16). However, at 30 to 46 years post-delivery, the adjusted HRs were significantly increased in women who had experienced pre-eclampsia (HR, 1.38), other hypertensive disorders (HR, 1.44), gestational diabetes (HR,1.19), large for gestational age delivery (HR, 1.17) or preterm delivery (HR, 1.11).
The findings were largely unexplained by genetic or environmental factors according to co-sibling analysis, the researchers noted. However, the development of other CVDs after pregnancy, especially chronic hypertension, substantially mediated the risk of AF.
Pre-eclampsia, other hypertensive disorders, large for gestational age delivery, gestational diabetes and preterm delivery should now be recognised as long-term risk factors for AF, the researchers concluded.
‘Women with adverse pregnancy outcomes need early preventive actions and long-term follow up for timely detection and treatment of cardiovascular disorders related to the development of AF,’ they wrote.
Associate Professor Monique Watts, Heart Failure Cardiologist and Lead of The Alfred Women’s Cardiology Clinic in Melbourne, said the study was a valuable contribution to the body of literature on pregnancy complications and subsequent CVD risk.
‘Importantly, the hazard ratios for AF were increased within 10 years’ postpartum, highlighting the fact that these complications impact women at a relatively young age,’ she told Medicine Today.
Professor Watts noted that international guidelines recommended clinicians counselled women about their future cardiovascular risk following pregnancy complications and offered appropriate follow up. However, precise guidance regarding what this process should involve was lacking, as were specialised services for postpartum women.
‘Women’s heart clinics are increasing in Australia and certainly cater to this group, but currently the bulk of this work falls on to the GP,’ Professor Watts said.
Obstetricians typically see patients until six weeks’ postpartum, whereas cardiologists often don’t see patients until disease has developed, she noted.
‘GPs are in a unique position to partner with women following pregnancy complications and implement potentially life-saving preventative care when it is really needed, which is early,’ Professor Watts said.
‘The impact of education and empowerment in these young women should not be underestimated.
‘Literature such as this latest study assists in building our knowledge to understand how to better care for women and inform much-needed guidelines.’