Pregnancy Complications Raise PAD Risk Up to 3.8x, Urging EHR Screening Alerts

Every year, roughly one in five pregnancies is complicated by gestational diabetes, preeclampsia, or preterm delivery. New research published in PLOS Medicine now shows that these common events elevate a woman’s risk of peripheral artery disease (PAD) decades later, with a 3.8-fold spike after gestational diabetes. For healthcare providers and health IT architects, this is a call to integrate pregnancy history into cardiovascular risk assessment algorithms, turning a universally collected piece of clinical data into a powerful trigger for preventive screening and chronic disease management.

A landmark Swedish cohort study of over 2 million deliveries has established that five major pregnancy complications are independently associated with a significantly elevated long-term risk of peripheral artery disease (PAD), a condition that foreshadows stroke, ischemic heart disease, and premature mortality. Led by Dr. Casey Crump of the University of Texas Health Science Center at Houston, the research, published in PLOS Medicine on July 21, 2026, found that women with a history of gestational diabetes faced a 3.8-fold higher relative rate of PAD up to 46 years after delivery compared to those with uncomplicated pregnancies. Small for gestational age, preterm delivery, other hypertensive disorders of pregnancy, and preeclampsia conferred relative risks ranging from 1.3-fold to 1.7-fold. Even within 10 years of delivery, preterm delivery, gestational diabetes, and small for gestational age already showed significant associations, highlighting an early window for intervention.

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New research published in PLOS Medicine now shows that these common events elevate a woman’s risk of peripheral artery disease (PAD) decades later, with a 3.8-fold spike after gestational diabetes.

This study is a critical extension of Crump’s prior work linking adverse pregnancy outcomes to heart disease, stroke, and heart failure. By focusing on PAD—an understudied but common vascular condition affecting millions worldwide—it fills a gap in women’s cardiovascular research. The findings are not merely observational. Co-sibling analyses, which compared exposed women with their unexposed sisters to control for shared genetic and environmental factors, demonstrated that the elevated risks persisted largely unchanged (adjusted hazard ratios remained significant in sibling comparisons), suggesting that the pregnancy complications themselves may trigger or accelerate underlying vascular pathology rather than simply being markers of pre-existing familial risk.

From a clinical perspective, the study transforms pregnancy history into a potent screening tool. Gestational diabetes emerged as the strongest single predictor, carrying a risk magnitude comparable to traditional risk factors like smoking or diabetes diagnosed outside pregnancy. The fact that the risk is detectable decades before PAD typically manifests offers a unique opportunity for proactive cardiovascular care. Primary care providers, obstetrician-gynecologists, and health systems can now incorporate a woman’s pregnancy history into cardiovascular risk assessment algorithms, scheduling earlier and more frequent vascular screening, blood pressure monitoring, and lipid management. The authors explicitly recommend that all major adverse pregnancy outcomes be recognized as long-term risk factors for PAD, a shift that could reshape preventive cardiology guidelines.

The implications for healthcare IT and population health are substantial. Electronic health record (EHR) systems could be augmented to automatically flag women with past pregnancy complications, triggering clinical decision support prompts for ankle-brachial index testing or referral to vascular specialists. In a value-based care environment, health plans could deploy outreach campaigns to these women, emphasizing blood pressure checks, diabetes screening, and cholesterol management—steps the study authors stress are never too late to lower PAD risk. With approximately 15–20% of pregnancies affected by one or more of these complications, the at-risk population is sizeable, potentially millions of women in the U.S. alone.