AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Long-Term Risks of Heart Failure and Atrial Fibrillation Following Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis
By Rastgou P, Servidoni ACP, Callado GY et al.
Background: Adverse pregnancy outcomes (APOs) are established sex-specific cardiovascular risk factors. While individual cohort studies have linked specific APOs to heart failure (HF) and atrial fibrillation (AF), no prior meta-analysis has comprehensively quantified these risks across multiple APO phenotypes or examined their persistence over extended durations of follow-up. Research Question: Are APOs associated with increased long-term risks of HF and AF, and do these risks persist across decades of follow-up? Methods: We performed a PRISMA-compliant systematic review and meta-analysis of studies evaluating associations between APOs and incident HF or AF. PubMed, Embase, Scopus, and Web of Science were systematically searched through April 2026.APOs included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preeclampsia, preterm delivery, small-for-gestational-age (SGA) birth, stillbirth, pregnancy loss, and composite APOs. Random-effects models were used to pool adjusted hazard ratios or odds ratios with 95% confidence intervals (CIs). Prespecified subgroup analyses were performed by APO subtype and duration of follow-up. Results: We identified 47 eligible observational studies including 29.9 million women. APOs were associated with significantly increased long-term risks of HF (HR 1.52, 95% CI 1.24-1.85) and AF (HR 1.39, 95% CI 1.24-1.56). Among APO subtypes, HDP conferred the highest risk, particularly severe/early-onset preeclampsia (HR 4.82, 95% CI 1.33-17.46) and superimposed preeclampsia (HR 3.06, 95% CI 1.04-9.02). Preterm delivery (HR 1.69, 95% CI 1.47-1.94) and GDM (HR 1.42, 95% CI 1.03-1.96) were also associated with elevated HF risk. For AF, HDP (HR 1.56, 95% CI 1.22-2.00), gestational hypertension (HR 1.61, 95% CI 1.12-2.33), preeclampsia (HR 1.36, 95% CI 1.30-1.43), and chronic hypertension in pregnancy (HR 2.27, 95% CI 1.79-2.88) were associated with increased arrhythmic risk (Figure 2). In time-stratified analyses, HF risk remained significantly elevated at 10-19 years (HR 1.90, 95% CI 1.70-2.12), 20-29 years (HR 1.42, 95% CI 1.07-1.89), and 30+ years (HR 1.89, 95% CI 1.62-2.21) after delivery. AF risk similarly persisted across follow-up intervals: HR 1.55 (95% CI 1.32-1.81) at 10 years, HR 1.30 (95% CI 0.95-1.78) at 10-19 years, and HR 1.14 (95% CI 0.92-1.42) at 30+ years (Figure 3). Conclusions: In this first comprehensive meta-analysis evaluating long-term maternal cardiovascular outcomes following APOs, APOs were associated with significantly elevated risks of both HF and AF persisting for more than three decades postpartum. HDP conferred the greatest cardiovascular risk, with severe/early-onset preeclampsia and superimposed preeclampsia more than tripling the long-term risk of HF.