Large global study links severe bleeding after childbirth to increased risk of cardiovascular disease

Women who experience severe bleeding after giving birth face elevated risks to their cardiovascular health that can persist for up to 15 years – a new analysis of data from over 9.7 million women across Europe, North America and Asia shows. 

The findings, which follow a review of research data some of which dates back to 1986, suggests that women who experience postpartum haemorrhage (PPH) have an increased risk to both cardiovascular conditions – such as heart failure, stroke, and ischemic heart disease – and thromboembolic events, such as blood clots.  

Published today in The Journal of Maternal-Fetal & Neonatal Medicine, the peer-reviewed results reveal these cardiovascular conditions are 1.76 times more likely, whilst thromboembolic incidents are 2.10 times more likely. 

While this increased risk is particularly acute in the first year after giving birth, it can persist for up to 15 years, especially among women with complications that lead to high blood pressure during pregnancy, such as preeclampsia. 

“PPH has long been seen as an emergency that ends once the bleeding stops. But our findings show it may have lasting effects on a woman’s heart health, even years after childbirth. We think this really calls for a broader view of maternal care, one that doesn’t stop at delivery, but continues into the months and years that follow,” says lead author Dr Manggala Pasca Wardhana, from the Department of Obstetrics and Gynecology, Faculty of Medicine, Airlangga University, in Indonesia. 

“If policymakers take this into account, it could lead to meaningful changes. For example, women who experience severe bleeding could be offered routine cardiovascular check-ups as part of their postpartum care.  

“These aren’t expensive interventions, but they could make a real difference in early detection and prevention of disease later on. 

“In the bigger picture, we hope this research helps shift the focus toward long-term maternal health. Because when we invest in mothers’ well-being beyond childbirth, we’re also investing in stronger families and healthier communities.” 

Each year, approximately 14 million women experience PPH – and it accounts for over 20% of all maternal deaths globally.
Beyond the immediate risk, emerging evidence indicates that PPH may also have long-term consequences for women’s health, in particular, the cardiovascular system.
It is understood that severe blood loss at delivery disrupts the hemodynamic stability (the ability of the cardiovascular system to maintain stable blood flow and deliver adequate oxygen to the tissues) and may trigger systemic effects. 

The systematic review and meta-analysis included ten studies published through 2024, based on research data gathered over a period spanning from 1986 to 2018. They included diverse geographic study populations in South Korea, the United Kingdom, Sweden, Canada, France and the United States, with follow-up periods ranging from three to 31 years. The researchers used sophisticated statistical methods to account for differences in study design and populations. 

Among findings, data analyses revealed the severity of PPH, particularly in women who need blood transfusions, was linked to a higher cardiovascular risk. 

The authors conclude that guidelines for the management of severe PPH should consider the risk of long-term cardiovascular health complications. 

“The relationship between bleeding after giving birth and risk to cardiovascular health is complex and multifactorial,” adds co-author Fiqih Faizara Ustadi, who is also based at Airlangga University. 

“Further research is now needed to better understand the mechanisms and develop strategies for the prevention and treatment of these potentially life-threatening complications, which may occur several years after childbirth.” 

While a key strength of this comprehensive analysis is its international scope, its reliance on data largely from high-income countries limits its broader applicability to low- and middle-income countries.  

“This study highlights the importance of addressing the long-term consequences of PPH on women’s health globally, particularly in low- and middle-income countries where the burden of PPH is greatest and access to postpartum care may be limited,” the authors add. 

A limitation of the paper is that a formal subgroup analysis based on geographic region (e.g., high-income vs low- and middle-income countries) was not performed in this review. This was because the included studies did not consistently report outcomes stratified by country income or healthcare context. 

However, the authors recognize that disparities in healthcare access, quality of emergency obstetric care, and availability of postpartum cardiovascular follow-up may influence long-term outcomes and could partly explain heterogeneity across studies.