THE HEART RESERVE GUIDE
Every pregnancy.
A part of your story.
Pregnancy history is heart history. Find out what research tells us, what follow-up is recommended, and where questions remain.
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YOUR HISTORY, EXPLAINED
Find your experience.
Choose any entry. Each separates the study finding, follow-up guidance and the question you can bring to a visit.
17 experiences · Open an entry to explore the evidence
Follow-up guidanceDiagnosed heart failure or cardiomyopathyAn existing heart diagnosis needs its own care plan.
What the evidence says
Peripartum cardiomyopathy is a diagnosed heart-muscle condition. It is different from a pregnancy history that may be associated with future disease. Recovery does not eliminate all risk, including risk in a subsequent pregnancy.
What follow-up is supported?
Ongoing cardiology review, reassessment of heart function and a medication plan should be individualized. The 2025 ESC guideline recommends counseling about recurrence and contraception even after recovery. Ask your team to record the next review and imaging date; do not stop treatment based on this tool.
“What is my current heart function, who is following it, and when should we reassess?”
Go to the source
2025 ESC pregnancy guideline · PPCM (opens in a new tab)Follow-up guidanceHigh blood pressure in pregnancyA pregnancy diagnosis that belongs in your ongoing care.
What the evidence says
A 2026 Nurses’ Health Study II analysis found later cardiovascular associations with gestational hypertension and preeclampsia, including after accounting for other pregnancy complications. HELLP and eclampsia should be recorded explicitly when diagnosed.
What follow-up is supported?
ACOG recommends a blood pressure assessment no later than 7–10 days after delivery for hypertensive pregnancy disorders, and within 72 hours for severe hypertension. Ongoing care depends on your readings and clinical history. Symptoms or severe readings need prompt assessment, not a wait for a scheduled visit.
“Who is reviewing my blood pressure after pregnancy, and when?”
Go to the source
Nurses’ Health Study II · 2026 (opens in a new tab)ACOG · Optimizing Postpartum Care (opens in a new tab)2026 AHA/ACC CKM guideline · section 7.5 (opens in a new tab)Follow-up guidanceGestational diabetesFollow-up matters even when blood sugar returns to normal.
What the evidence says
Gestational diabetes is associated with later type 2 diabetes and cardiovascular disease. In Nurses’ Health Study II, the adjusted cardiovascular hazard ratio was 1.43 (95% CI 1.12–1.81).
What follow-up is supported?
ADA recommends a 75-g oral glucose tolerance test at 4–12 weeks postpartum, then screening every 1–3 years even if the initial result is normal. If that first window was missed, discuss an appropriate current test with your clinician.
“Was my after-pregnancy glucose test completed, and when is my next screen?”
Go to the source
Nurses’ Health Study II · 2017 (opens in a new tab)ADA Standards of Care · 2026 (opens in a new tab)Cohort findingTwins & other multiplesThe number of babies is part of your heart history.
What the evidence says
A 2025 US study found a higher hazard of cardiovascular readmission in the first postpartum year after twins without hypertensive disorders (HR 1.95; 95% CI 1.75–2.17) and twins with hypertensive disorders (HR 8.21; 7.48–9.01), compared with singletons without those disorders. These estimates do not establish lifelong risk and must not be applied to triplets or more.
What follow-up is supported?
The study supports closer postpartum surveillance, but does not establish one twin-specific testing schedule. Discuss the timing of your postpartum review with your care team, especially if you had high blood pressure or heart symptoms.
Maternal follow-up after TTTS or a multiple pregnancy
“Does my multiple pregnancy change the follow-up I need now?”
Go to the source
Rutgers-led US delivery cohort · 2025 (opens in a new tab)Evidence still developingTwin-to-twin transfusion syndrome (TTTS)Keep the mother’s findings and follow-up in the story.
What the evidence says
Small observational studies report maternal circulatory and biomarker changes around laser treatment. A September 2026 study adds biomarker evidence. These studies did not measure long-term maternal cardiovascular outcomes or establish a testing schedule.
What follow-up is supported?
A validated TTTS-specific long-term maternal cardiac surveillance schedule was not identified in the guidance reviewed. Ask your clinician to review documented maternal complications, current findings and the discharge plan, then record the agreed next action and timing. Fetal surveillance after laser is separate from maternal cardiac follow-up. These studies do not establish routine biomarker panels or a fixed imaging schedule.
After TTTS: specific questions and the maternal evidence
“Which maternal findings from my TTTS pregnancy still need follow-up, what has already been reviewed, and who will take responsibility for the next step and its timing?”
Go to the source
Maternal circulation around laser · 2024 (opens in a new tab)Maternal biomarkers around laser · September 2026 (opens in a new tab)SMFM Consult #72 · fetal TTTS guidance (opens in a new tab)Cohort findingMiscarriage & recurrent lossYou can include a loss, even if it happened many years ago.
What the evidence says
Among 77,701 Women’s Health Initiative participants, one miscarriage was associated with higher adjusted odds of later coronary heart disease (OR 1.19; 95% CI 1.08–1.32); two or more had OR 1.18 (1.04–1.34). Ischemic stroke was not significantly associated in that study. This does not establish that a loss causes heart disease.
What follow-up is supported?
Recurrent spontaneous pregnancy loss is a reproductive risk marker in the 2026 lipid guideline. ACOG recommends a pregnancy-loss evaluation after two miscarriages. That evaluation is distinct from cardiac testing; a dedicated cardiac surveillance schedule after miscarriage was not identified.
“Does my pregnancy-loss history change what we should discuss about prevention?”
Go to the source
Women’s Health Initiative · 2014 (opens in a new tab)ACOG · Repeated Miscarriages (opens in a new tab)2026 dyslipidemia guideline · reproductive markers (opens in a new tab)Cohort findingStillbirthYour care and your history still matter after loss.
What the evidence says
The Women’s Health Initiative found higher adjusted odds of coronary heart disease after at least one stillbirth (OR 1.27; 95% CI 1.07–1.51). This is an observational association in postmenopausal women, not an individual prediction.
What follow-up is supported?
Keep the timing and cause, if known, in your history. Obstetric follow-up, support after loss, and a discussion of cardiovascular risk factors are appropriate topics. A universal stillbirth-specific cardiac imaging schedule was not identified.
“What follow-up do I need for my own health after this loss?”
Go to the source
Women’s Health Initiative · 2014 (opens in a new tab)ACOG · Postpartum care and pregnancy loss (opens in a new tab)Follow-up guidancePreterm deliveryHow early—and why—helps explain the history.
What the evidence says
Nurses’ Health Study II found higher cardiovascular hazard after a first delivery before 37 weeks (HR 1.42; 95% CI 1.16–1.72). Record the week and whether birth was spontaneous, medically indicated, or planned because of multiples.
What follow-up is supported?
Preterm birth is included in the adverse-pregnancy-outcome prevention pathway. The 2026 CKM guideline recommends risk-factor screening at least once in the first postpartum year and transition to ongoing primary care; earlier condition-specific deadlines apply.
“What does the timing and reason for my early delivery mean for my care now?”
Go to the source
Nurses’ Health Study II · 2017 (opens in a new tab)2026 AHA/ACC CKM guideline · section 7.5 (opens in a new tab)Follow-up guidanceA small baby or growth restrictionKeep the diagnosis as well as the birthweight, if known.
What the evidence says
A Swedish national cohort found small-for-gestational-age birth associated with later ischemic heart disease (HR 1.18; 95% CI 1.16–1.20). Small for gestational age, fetal growth restriction, and low birthweight are different descriptions; preserve what your records actually say.
What follow-up is supported?
Small-for-gestational-age birth is included in the 2026 CKM prevention pathway: risk-factor screening within the first postpartum year and transition to primary care. Individual tests depend on clinical context.
“Was my baby small for gestational age or growth restricted, and does that change my follow-up?”
Go to the source
Swedish national and co-sibling cohort · BMJ 2023 (opens in a new tab)2026 AHA/ACC CKM guideline · section 7.5 (opens in a new tab)Follow-up guidancePlacental abruptionEarly separation of the placenta belongs in your health record.
What the evidence says
A 2026 New Jersey cohort found higher nonfatal cardiovascular hospitalization hazard after abruption in a first delivery (HR 1.27; 95% CI 1.11–1.46), with a median follow-up of 16 years. Other placental problems should not be assumed to have the same estimate.
What follow-up is supported?
Abruption is included among adverse pregnancy outcomes in the 2026 CKM guideline. Review blood pressure, lipids, glucose and kidney health within the first postpartum year, with ongoing primary care and earlier review as indicated.
“Was my placenta problem an abruption, and what follow-up belongs in my plan?”
Go to the source
New Jersey PACER cohort · 2026 (opens in a new tab)2026 AHA/ACC CKM guideline · section 7.5 (opens in a new tab)Cohort findingSevere bleeding or transfusionSeverity and the care you needed make a difference.
What the evidence says
A US cohort found postpartum hemorrhage requiring transfusion associated with a 67% higher cardiovascular readmission hazard during available follow-up in the delivery calendar year. Hemorrhage without transfusion did not show the same association. The study does not show that transfusion causes cardiovascular disease.
What follow-up is supported?
Record transfusion, any organ injury and whether recovery and anemia were reviewed. A dedicated long-term cardiac testing schedule solely for hemorrhage was not identified.
“Have we reviewed my recovery and any unresolved findings after the bleeding?”
Go to the source
US postpartum hemorrhage cohort · 2026 (opens in a new tab)Cohort findingPostpartum depressionEmotional health belongs in the same conversation.
What the evidence says
A 2026 English cohort of about 1.4 million women found postnatal depression associated with later cardiovascular disease (HR 1.56; 95% CI 1.50–1.62), as well as hypertension, diabetes and kidney disease. Shared factors may contribute to these associations.
What follow-up is supported?
Depression deserves assessment and treatment in its own right. A special cardiac testing schedule solely for postpartum depression was not established by this cohort.
“Can we review my emotional health alongside my physical recovery and prevention needs?”
Go to the source
English primary-care cohort · 2026 (opens in a new tab)Cohort findingA large-for-gestational-age babyA possible clue for a conversation about blood sugar.
What the evidence says
A 2026 English cohort found higher subsequent type 2 diabetes rates after large-for-gestational-age birth, including without diagnosed gestational diabetes. This finding concerns diabetes; it does not establish an independent heart-disease multiplier.
What follow-up is supported?
Discuss whether glucose screening is appropriate based on your full history and current risk factors. A condition-specific cardiac testing schedule was not identified.
“Does my baby’s size or my pregnancy glucose history change when I should be screened for diabetes?”
Go to the source
English primary-care cohort · 2026 (opens in a new tab)Cohort findingCholestasis of pregnancyLiver follow-up and heart-risk evidence are different questions.
What the evidence says
A Swedish cohort found a modest association with later cardiovascular disease after intrahepatic cholestasis of pregnancy (HR 1.12; 95% CI 1.06–1.19). This is not an established personal risk adjustment.
What follow-up is supported?
RCOG recommends checking that itching has resolved and that liver tests and bile acids have normalized at the six-week postnatal check. Persistent symptoms or abnormal results may need specialist review. This is liver follow-up, not a cardiac surveillance schedule.
“Were my liver tests and bile acids checked again after pregnancy?”
Go to the source
Swedish population cohort · 2015 (opens in a new tab)RCOG · Cholestasis follow-up (opens in a new tab)Evidence still developingHyperemesis gravidarumSevere pregnancy sickness has mixed cardiovascular evidence.
What the evidence says
A Quebec cohort found increased cardiovascular hospitalization after hyperemesis alone (HR 1.46; 95% CI 1.38–1.54). A Norwegian cohort did not find a significant increase in its overall cardiovascular endpoint (HR 1.08; 0.99–1.18). The outcomes and populations differ.
What follow-up is supported?
Record severe sickness and any ongoing nutritional, electrolyte or other problems for clinical review. A dedicated long-term cardiac testing schedule was not identified. The evidence should be described as mixed.
“Is there anything from my severe pregnancy sickness or recovery we still need to review?”
Go to the source
Quebec cohort · 2023 (opens in a new tab)Norwegian cohort · 2019 (opens in a new tab)Evidence still developingMirror syndromeRecord a maternal diagnosis separately from a baby’s hydrops.
What the evidence says
Mirror syndrome is a maternal complication associated with fetal hydrops. SMFM recognizes serious maternal risks during the affected pregnancy. This does not establish a numerical long-term maternal cardiovascular-risk estimate.
What follow-up is supported?
If currently diagnosed, care belongs with the obstetric specialist team. After the pregnancy, record any maternal blood pressure, lung, kidney or heart complications and confirm their recovery. A mirror-syndrome-specific long-term cardiac screening schedule was not identified.
“Which maternal complications occurred, and has their recovery been confirmed?”
Go to the source
SMFM Consult #75 · Nonimmune hydrops, 2026 (opens in a new tab)Follow-up guidanceOther diagnosed complicationsA blood clot, stroke, rhythm disorder, kidney injury or serious infection needs specific follow-up.
What the evidence says
These are different diagnoses with different outcomes. A single pregnancy-risk multiplier cannot represent them. Keep the actual diagnosis, date, treatment and any unresolved findings in your history.
What follow-up is supported?
ACOG recommends timely coordinated follow-up for pregnancy complications and chronic conditions. Ask the treating team who owns your follow-up, what recovery needs checking and when. A diagnosed cardiovascular condition may also require a Pregnancy Heart Team or cardiology plan.
“Who is responsible for follow-up of this diagnosis, and what is the next review date?”
Go to the source
ACOG · Optimizing Postpartum Care (opens in a new tab)2025 ESC · Cardiovascular disease and pregnancy (opens in a new tab)What do the numbers mean?
HR is a hazard ratio; OR is an odds ratio. They compare groups. An HR of 1.5 is not a 50% chance of disease. Confidence intervals describe statistical uncertainty. Different outcomes and time periods cannot be added together.
A history is not a risk score.
These findings do not add points to your Heart Story or change a PREVENT result. A clinician considers your current health and pregnancy history together. A missing follow-up schedule does not mean no care is needed.
This guide concerns maternal health. Babies who experienced TTTS need their own pediatric follow-up. This is a selected educational review, not an exhaustive review or an independently approved clinical pathway. Existing heart disease, blood clots, stroke or kidney injury need their own clinical care plan. For new or severe chest pain, severe trouble breathing, fainting or signs of stroke, call 911.
ASK. RECORD. RESPOND.
Keep the history.
Bring the question.
Your Heart Story gives you one place to prepare for your next conversation.
Start my Heart StoryAfter a twin pregnancy
Your babies had a medical history. So did you.
A guide and appointment sheet for your health after a complicated twin pregnancy.
Explore the twin pregnancy guideFind an explanation for the next conversation
How this check was built
Sources and review status.
These foundational sources complement the dated sources in each entry. This guide cannot estimate your personal risk or assign tests or treatments.
Sources
- Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026American Diabetes Association Professional Practice Committee · 2026
- Adverse Pregnancy Outcomes and Cardiovascular Disease RiskAmerican Heart Association · 2021
- Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy OutcomesAmerican Heart Association · 2024
- Optimizing Postpartum CareAmerican College of Obstetricians and Gynecologists · 2018
These sources inform the educational content; they do not endorse HEART RESERVE. Independent clinical review will be named only after the exact material has been reviewed and attribution approved in writing.
Read the editorial and review standardWith gratitude
Support for the Pregnancy & Heart History initiative.
Lindsey Wimmer and Star Legacy Foundation shared guidance, including feedback from the Foundation’s medical advisors, that helped shape the questions in this check.
Star Legacy Foundation applauds this important initiative to increase awareness of, and screening for, cardiovascular risk later in life among women who experienced complicated pregnancies and poor pregnancy outcomes. We appreciate the recognition that pregnancy loss and other adverse pregnancy outcomes carry lasting implications for a woman’s long-term health. Growing evidence continues to illuminate the significant interconnection between pregnancy health and cardiovascular health, underscoring the need for sustained attention before, during and after pregnancy. We are grateful for this program that will help health professionals translate this knowledge into clinical practice and improved outcomes for families.
This statement supports the Pregnancy & Heart History initiative. It does not establish a formal partnership, validation of this tool, or endorsement of the full HEART RESERVE book.