A new study of nearly 9,000 pregnant women found that having better cardiovascular health before pregnancy—meaning good exercise habits, healthy eating, quality sleep, not smoking, healthy weight, and normal blood pressure—is linked to fewer pregnancy complications. Researchers estimated that if women improved their heart health before getting pregnant, they could prevent up to 40% of serious pregnancy problems like high blood pressure during pregnancy, gestational diabetes, and early delivery. The study suggests that focusing on overall heart health in the months before pregnancy might be one of the most important things women can do to have healthier pregnancies.

The Quick Take

  • What they studied: Whether women with better heart and overall health before pregnancy have fewer serious pregnancy problems, and how many complications could be prevented if more women improved their health before conceiving.
  • Who participated: 8,927 pregnant women, average age 27 years old, who were having their first baby and didn’t have high blood pressure or diabetes before pregnancy. About 1 in 4 of these women experienced a serious pregnancy complication.
  • Key finding: Women with lower cardiovascular health scores had 46% higher risk of pregnancy complications. If all women improved their heart health to a score of 80 out of 100, about 15% of pregnancy complications could be prevented. If everyone achieved perfect heart health (score of 100), up to 40% of complications could be prevented.
  • What it means for you: If you’re planning to get pregnant, improving your exercise, diet, sleep, weight, and blood pressure before conception may significantly reduce your risk of pregnancy complications. This is especially important if you currently have unhealthy habits. Talk to your doctor about creating a pre-pregnancy health plan.

The Research Details

Researchers looked at pregnant women from a large study called the Nulliparous Pregnancy Outcomes Study (women having their first baby). They measured each woman’s cardiovascular health in the first three months of pregnancy by looking at six factors: how much they exercised, what they ate, how well they slept, whether they used nicotine, their body weight compared to height, and their blood pressure. They gave each woman a score from 0 to 100, with higher scores meaning better heart health.

The researchers then tracked which women developed serious pregnancy problems: high blood pressure during pregnancy, gestational diabetes (diabetes that develops during pregnancy), or preterm birth (delivering before 37 weeks). They used statistical methods to figure out how much of the risk for these problems was connected to cardiovascular health.

Finally, they did calculations to estimate: if women with poor cardiovascular health improved to different levels, how many pregnancy complications could be prevented? They looked at three scenarios: improving from very poor to poor health, improving from poor to good health, and improving to excellent health.

This research approach is important because it helps doctors understand not just whether heart health matters for pregnancy, but how much it matters. By estimating how many complications could be prevented, the study shows that improving cardiovascular health before pregnancy might be one of the most effective ways to prevent serious pregnancy problems. This information can help doctors and public health officials decide where to focus prevention efforts.

This study has several strengths: it included a large number of women (nearly 9,000), measured health factors early in pregnancy before complications developed, and looked at multiple types of pregnancy complications. The study was published in a respected medical journal. However, the study observed women over time rather than randomly assigning them to different health programs, so we can’t be completely certain that improving health would definitely prevent complications—only that the two are strongly connected. The calculations about how many complications could be prevented are estimates based on the patterns they observed, not guaranteed outcomes.

What the Results Show

The main finding was clear: women with lower cardiovascular health scores had significantly higher risk of pregnancy complications. For every 10-point decrease in the cardiovascular health score, the risk of complications increased by about 46%. About 1 in 4 women in the study experienced a serious pregnancy problem.

When researchers calculated how many complications could be prevented through different levels of improvement, they found a dose-response relationship—meaning the more women improved their health, the more complications could be prevented. If women with very poor cardiovascular health (scores below 50) improved to a score of 50, about 12% of all pregnancy complications could be prevented. This would affect about 6% of the pregnant population.

The bigger improvements came with more substantial health changes. If women with poor cardiovascular health (scores below 80) improved to a score of 80, about 15% of pregnancy complications could be prevented—affecting more than half of the pregnant population. The most dramatic potential benefit came from universal improvement: if every woman achieved excellent cardiovascular health (a score of 100), approximately 40% of all pregnancy complications could be prevented.

These benefits were consistent across all three types of complications studied: high blood pressure during pregnancy, gestational diabetes, and preterm birth. Each complication showed similar patterns of risk reduction with improved cardiovascular health.

The study found that the relationship between cardiovascular health and pregnancy complications was consistent across different types of complications, suggesting that heart health affects pregnancy through multiple pathways. The fact that even modest improvements in cardiovascular health (from very poor to poor) showed measurable benefits suggests that women don’t need to achieve perfect health to see meaningful risk reduction. The study also showed that the benefits of improving cardiovascular health were greatest when the largest number of women were affected—meaning that public health efforts to improve cardiovascular health in women of childbearing age could have substantial population-wide benefits.

This study builds on previous research showing that maternal cardiovascular health matters for pregnancy outcomes. However, this is one of the first studies to estimate how many pregnancy complications could actually be prevented by improving cardiovascular health before pregnancy. Previous studies have shown that individual factors like obesity, smoking, and high blood pressure increase pregnancy risk, but this study looked at all these factors together as part of overall cardiovascular health. The findings are consistent with other research showing that lifestyle factors before pregnancy are important, and they suggest that a comprehensive approach to heart health may be more effective than focusing on single factors.

This study has several important limitations to consider. First, it only included women having their first baby who didn’t already have high blood pressure or diabetes before pregnancy, so the results may not apply to women with these conditions or women who have been pregnant before. Second, the study measured cardiovascular health early in pregnancy, not before pregnancy, so we don’t know if the same relationships would apply if health was measured earlier. Third, the study observed women over time rather than randomly assigning them to different health programs, so we can’t be completely certain that improving health would prevent complications—only that they’re connected. Fourth, the estimates about how many complications could be prevented are based on mathematical calculations from the patterns observed, not on actual intervention studies, so real-world results might differ. Finally, the study didn’t measure all possible factors that might affect pregnancy outcomes, such as stress, mental health, or access to healthcare.

The Bottom Line

Women planning to become pregnant should focus on improving their cardiovascular health before conception by: exercising regularly (at least 150 minutes per week of moderate activity), eating a healthy diet rich in fruits, vegetables, and whole grains, getting 7-9 hours of quality sleep per night, maintaining a healthy weight, not smoking or using nicotine products, and keeping blood pressure in the normal range. These recommendations are supported by strong evidence (this study plus extensive previous research). Talk to your doctor about your specific health situation and create a personalized pre-pregnancy health plan. Even modest improvements in these areas may reduce your risk of pregnancy complications.

This research is most relevant for women who are planning to become pregnant or might become pregnant in the next year or two. It’s especially important for women with unhealthy lifestyle habits, overweight or obesity, high blood pressure, or poor diet and exercise patterns. Women who have already had pregnancy complications should definitely discuss cardiovascular health with their doctor before future pregnancies. This information is less directly applicable to women who are not planning to become pregnant, though the cardiovascular health recommendations are beneficial for everyone. Men should also care about this research because they can support their partners in making these healthy changes.

Realistic improvements in cardiovascular health typically take 3-6 months to develop. For example, regular exercise habits usually improve fitness and blood pressure within 4-8 weeks, weight loss takes several months, and dietary changes show benefits within weeks to months. Ideally, women should begin improving their cardiovascular health 3-6 months before trying to become pregnant, though even improvements made during early pregnancy may provide some benefit. The benefits of these lifestyle changes extend beyond pregnancy—they reduce the risk of heart disease, diabetes, and other health problems throughout life.

Want to Apply This Research?

  • Track weekly exercise minutes (goal: 150+ minutes of moderate activity), daily sleep hours (goal: 7-9 hours), and weekly diet quality using a simple scoring system (servings of fruits, vegetables, whole grains, and processed foods). Monitor blood pressure monthly if available.
  • Set a specific, measurable goal such as: ‘I will exercise 30 minutes, 5 days per week’ or ‘I will go to bed by 10 PM on weeknights to get 8 hours of sleep’ or ‘I will eat vegetables with lunch and dinner every day.’ Use the app to log progress daily and receive reminders and encouragement.
  • Calculate a monthly cardiovascular health score based on the six factors (exercise, diet, sleep, nicotine use, BMI, blood pressure) and track how the score improves over time. Set milestone goals (improving from score 60 to 70, then 70 to 80, etc.) and celebrate achievements. Share progress with your healthcare provider at regular check-ups.

This research suggests associations between cardiovascular health and pregnancy outcomes but does not provide medical advice. The findings are based on observational research and estimates, not guaranteed outcomes. Individual results may vary based on genetics, medical history, and other factors. Women planning pregnancy should consult with their healthcare provider before making significant lifestyle changes or starting any new exercise program. This information is not a substitute for professional medical advice, diagnosis, or treatment. If you have existing health conditions, take medications, or have had previous pregnancy complications, discuss these findings with your doctor to determine how they apply to your specific situation.