Trigger warning: pregnancy loss
I grew up in a cardiologist’s house. An anatomically correct plastic heart sat on our kitchen counter next to the salt shaker, as ordinary as the mail or the fruit bowl. If my father was late picking us up from swim practice, my siblings and I would wait in the back rooms of the cardiac catheterization lab in our towels and swim caps, watching grainy black-and-white images of blocked arteries open before heading home for dinner. The heart was never abstract in my childhood. It was mechanical and urgent and visible.
I went on to medical school and eventually became an OB-GYN. For more than a decade, I have cared for women through pregnancies, complications, deliveries, and loss. My professional life has been built around protecting women’s health across every stage, from the first cycle through menopause and beyond. And still, I missed something about my own heart.
My pregnancies were not simple. I had preeclampsia, a dangerous rise in blood pressure that can develop during pregnancy. I developed gestational hypertension, another form of pregnancy-related high blood pressure. I went into preterm labor and delivered early and experienced the devastation of stillbirth.
At the time, those diagnoses felt like obstetric crises to survive. They were emotional and physical upheavals that reshaped my understanding of motherhood and medicine. They did not feel like cardiovascular warnings.
Years later, while preparing for additional certification in menopause medicine, I began reading more deeply about long-term health after complicated pregnancies. The studies themselves were not brand new. Researchers had been documenting the connections between pregnancy complications and future heart disease for years. But those findings had never been emphasized in my earlier education.
Medical education is dense and demanding. Physicians are asked to master enormous amounts of information in order to care for women from adolescence through pregnancy and into midlife. But as I read those papers, I could not shake the feeling that this was something worth flagging more clearly, especially when cardiovascular disease remains the leading cause of death in the very population I was training to protect.
Study after study pointed to the same pattern. Preeclampsia is associated with roughly double the lifetime risk of heart disease. Gestational hypertension carries its own long-term risks for chronic high blood pressure and stroke. Gestational diabetes can signal future metabolic disease. Even delivering a baby early has been linked to a higher likelihood of heart disease later in life.
I remember closing one of those studies and realizing that what I had once filed away as difficult pregnancies were actually clues.
The realization felt like both an epiphany and a quiet grief. The epiphany was the sudden clarity that my pregnancies had not only been reproductive events but physiologic stress tests. My cardiovascular system had already demonstrated how it responds under strain. My strong family history of heart disease; my elevated lipoprotein(a), a genetic cholesterol marker linked to higher heart risk; and my obstetric complications formed a pattern that now felt impossible to ignore.
The grief was more subtle. Even with a cardiologist father, years of medical school and experience in women’s health, I hadn’t fully integrated my reproductive history into my cardiovascular risk story. The data had existed, but the connection had not been made urgent enough, cohesive enough, or loud enough across specialties to feel significant.
If I felt startled by that realization, how could my patients possibly be expected to know?
Cardiovascular disease remains the leading cause of death in women in the United States. It kills more women each year than all cancers combined. And yet many women still think of heart disease as something that happens later in life or primarily to men. We talk about breast cancer with clarity and urgency. We rarely speak about heart disease with the same cultural force, even though it claims more lives.
Part of the problem is how we frame women’s symptoms and risk. For decades, the textbook image of a heart attack centered on a man clutching his chest. When female patients present with shortness of breath, nausea, jaw pain, profound fatigue, or chest pressure without dramatic radiating pain, those symptoms have often been described as atypical.
But women are not atypical. We are half the population. Our biology is not an exception to a rule. It is part of the rule.
Women are also more likely to develop certain forms of heart disease that don’t show up the way doctors were traditionally trained to expect. Instead of a large blocked artery, women may develop problems in the heart’s smaller blood vessels, known as microvascular disease. Women are also more likely to develop a form of heart failure in which the heart still pumps but becomes stiff and less able to relax.
Pregnancy may be one of the clearest windows we have into how a woman’s cardiovascular system responds to stress. During pregnancy, blood volume rises dramatically, the heart works harder, and the vascular system must adapt quickly. When complications such as preeclampsia, gestational hypertension, or gestational diabetes arise, they can reveal how the body responds under metabolic and hemodynamic strain.
The six week postpartum visit often closes the chapter on pregnancy — emotionally and clinically. But from a cardiovascular perspective, it may only be opening one.
This does not mean that if you had preeclampsia you are destined for a heart attack. It means your pregnancy history belongs in conversations about blood pressure, cholesterol, inflammation, and long-term prevention. It means what happened during pregnancy should not simply sit archived in an old chart, because it’s part of your ongoing health story. And it’s something worth mentioning to your doctor, even years after your last pregnancy.
I can’t change my history of preeclampsia or preterm delivery. But I can monitor my blood pressure with new context. I can interpret my laboratory results differently. I can speak to my patients with greater clarity about what their bodies have already revealed.
Knowledge does not create risk. It illuminates it. And when cardiovascular disease remains the number one killer of women, illumination is not optional. It’s foundational.
Sarah Berg, MD, is a board-certified OB-GYN and certified menopause practitioner who spent over a decade in clinical practice caring for women across all stages of life. She now focuses on evidence-based education and storytelling that helps women understand their bodies, prioritize preventative care, and navigate midlife health with clarity and confidence. Learn more at Selfority.
