Cardiovascular Risks Rise With Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy accompanied by substantial cardiometabolic burden are associated with increased odds of cardiovascular severe maternal morbidity, according to study results presented at the 2026 American College of Obstetricians & Gynecologists (ACOG) Annual Clinical & Scientific Meeting, held in Washington, District of Columbia, from May 1 to 3, 2026.

Hypertensive disorders of pregnancy are a leading contributor to maternal cardiovascular complications, and coexisting metabolic conditions may further increase this risk. Whether COVID-19 infection or the pandemic period altered this relationship has remained unclear.

Incorporating this stratification into peripartum care could guide targeted monitoring and timely intervention to reduce cardiovascular complications.

Researchers conducted a retrospective cohort study using linked birth certificate data and hospitalization claims from the New Jersey Integrated Population Health Data Project. The study included 62,924 pregnancies and spanned from 2017 to 2021. The researchers used latent class analysis to group participants into distinct risk categories based on hypertensive disorders of pregnancy status and coexisting cardiometabolic conditions. They estimated adjusted odds ratios (aORs) for cardiovascular severe maternal morbidity from delivery through 42 days postpartum, adjusting for COVID-19 infection, COVID-19 pandemic period, race, and additional clinical covariates.

The researchers identified 3 distinct risk groups: a low-risk group without hypertensive disorders of pregnancy or major comorbidities (91.35%), a group with moderate metabolic burden but no hypertensive disorders of pregnancy (4.50%), and a high-risk group characterized by both hypertensive disorders of pregnancy and substantial cardiometabolic burden (4.15%).

Compared with the low-risk group, the moderate-risk group had higher odds of cardiovascular severe maternal morbidity (aOR, 1.81; 95% CI, 1.13-2.77). The high-risk group also had higher odds of cardiovascular severe maternal morbidity (aOR, 2.35; 95% CI, 1.50-3.53).

Black racial identity was independently associated with higher odds of cardiovascular severe maternal morbidity (aOR, 1.77; 95% CI, 1.24-2.54). In contrast, neither COVID-19 infection nor the pandemic period was associated with an increased odds of cardiovascular severe maternal morbidity in this cohort.

“Incorporating this stratification into peripartum care could guide targeted monitoring and timely intervention to reduce cardiovascular complications,” the study authors concluded.