Ahhhh, pregnancy. It is a beautiful state: rosy cheeks, a belly everyone wishes to touch, and that inner glow. It's magical. Of course, there are also the spider veins, stretch marks, swollen feet, joint relaxation, and a host of other nonmagical discomforts that sometimes persist as well. But what many women do not know is that pregnancy also can have long-term health hazards that require careful attention.

Almost two-thirds of women will deliver at least one baby in their lives, and one-third of all pregnancies are affected by a condition associated with lifelong risks. The three most common risky conditions are hypertensive disorders of pregnancy, gestational diabetes, and excessive weight gain.

High blood pressure in pregnancy takes many forms. Gestational hypertension is just that—high blood pressure during pregnancy. When this begins to injure certain organs, such as the kidneys, liver, or nervous system, it becomes known as preeclampsia. This can worsen further with seizures (eclampsia) or with severe organ dysfunction called HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet counts).
These illnesses often require a mother to deliver early, as this is the only real cure. Purely pregnancy-related hypertension should resolve within about 3 months of delivery, but a small number of women will develop longstanding high blood pressure.

Blood pressure problems in pregnancy are reasonably likely to happen in subsequent pregnancies, with a 15%-40% chance of it occurring in a subsequent pregnancy, depending on how early in the pregnancy the hypertension started, as well as other risk factors. Women who have hypertension in pregnancy are twice as likely to have long-term hypertension and more than twice as likely to have a stroke as other women.

Since heart disease is the No. 1 killer of women, it is important for women who have had hypertension during their pregnancies to see their providers every 3 years to make sure their blood pressure, cholesterol, weight, and blood sugar are well-controlled. Women who had to be delivered before 37 weeks, women with babies born at lower-than-expected weights, and those with more than one pregnancy affected by hypertension should be checked every year. Care providers for the babies need to be informed as well, as these children have twice the risk of high blood pressure, obesity, diabetes, and other health problems as adults.

Blood sugar is also important during pregnancy—growing a whole new human requires sugar to be around for fuel. A mother’s body adjusts to keep more sugar circulating in order to do this, which is a normal process. But some additional underlying problems—including starting at a higher weight, certain ethnic backgrounds, older moms, and those with family members with diabetes—can lead to sugar levels higher than the mother’s body can adapt to. This results in gestational diabetes in 5%-15% of pregnant women.

The American College of Obstetricians and Gynecologists (ACOG) recommends that all women be screened for diabetes during pregnancy, which is formally diagnosed and treated in a variety of ways. However, after delivery, several health problems are more likely.

ACOG and the American Diabetes Association recommend that women with gestational diabetes should be tested 4-12 weeks after delivery to rule out underlying type 2 diabetes. If that test is normal, they should be rescreened every 1-3 years. Ongoing screening is important because 70% of women with gestational diabetes will go on to develop type 2 diabetes in the two decades after pregnancy. This group of women has four times the risk of stroke or heart attack. Even worse, women who do not formally develop type 2 diabetes are not off the hook. They carry a one-third higher risk for stroke and heart attack. These risks can be diminished by returning to a healthy weight, exercising, and not smoking. The children of mothers who have gestational diabetes are at higher risk of diabetes and obesity, too.

The highest obesity risk in children is in those whose mothers were overweight before getting pregnant. By age 4, almost 25% of children born to women with a BMI over 30 in the first trimester are obese. Children of women who start at a normal weight, but gain more than is recommended are twice as likely to be obese by age 8.

The pregnant mothers also have a host of additional pregnancy-related complications to contend with, including higher risk for both hypertension and diabetes in the pregnancy, infection, prolonged labor, and a much higher risk of having a cesarean delivery.

Optimizing health, including starting pregnancy at a normal weight and following recommendations for weight gain, greatly reduces these problems and can eliminate the associated lifetime health risks.

Women who start pregnancy at a healthy weight are 9 times more likely to return to that healthy weight after delivery, according to research published in 2013.

One of the best predictors of staying healthy in pregnancy is maintaining exercise. Only a few pregnancy risks require modifying exercise routines. ACOG recommends that most pregnant women exercise at least 30 minutes five or more days per week.

Maintaining good health before and during pregnancy is important, but it is equally important to be aware of long-term risks resulting from pregnancy complications. While the risks are reduced by a healthy lifestyle, periodic monitoring and assessment by a health-care provider can reduce pregnancy-related chronic illness and can even prevent early death.