The Healthiest Pregnancy Often Begins Before You’re Pregnant
- Divyanshu Kumar
- Jul 15
- 6 min read
What every woman deserves to know about heart, kidney, and metabolic health, long before the first prenatal visit.
Written by Dr. Divyanshu Kumar (Guest Author) · Edited by Saneka Chakravarty, MD, FACC
If you're thinking about pregnancy, whether soon or somewhere further down the road, some of the most important preparation happens before you ever conceive. And more and more, that preparation comes down to your heart, kidney, and metabolic health.
Here's a trend worth knowing: a growing share of women are entering pregnancy already managing a condition like high blood pressure or diabetes. Between 1989 and 2018, the share of pregnant women with chronic high blood pressure roughly tripled, and the share with diabetes nearly quadrupled. These are still not the majority experience, but the direction is clear, and understanding it puts genuine power in your hands.
This isn't about anything women are doing wrong. It reflects broad changes in how we live, eat, and access care. And it means the one thing we can most influence, prevention, matters more than ever.
First, the reassuring part
Even as more women enter pregnancy with these conditions, pregnancy-related deaths linked to high blood pressure and diabetes haven’t risen at the same pace. Better screening, prenatal care, and treatment likely explain part of that. The data can’t confirm every reason, but the pattern is encouraging: recognizing and managing these conditions early makes a real difference.
“Steady,” though, doesn’t mean “solved.” Outside of pregnancy, deaths related to high blood pressure and diabetes among women aged 15 to 45 continue to climb. That’s exactly why prevention deserves attention well before conception.
What is a hypertensive disorder of pregnancy?
You’ll see the term hypertensive disorders of pregnancy (HDP) a lot in maternal health. It covers high blood pressure conditions before or during pregnancy:
Chronic hypertension:- high blood pressure present before pregnancy
Gestational hypertension:- high blood pressure that develops after 20 weeks
Preeclampsia:- a more serious condition that can affect the kidneys, liver, and other organs
HDP has become one of the fastest-growing pregnancy complications in the country, rising from about 1 in 10 deliveries in 2016 to nearly 1 in 6 by 2022.
Why this matters for both of you
Cardiometabolic health, how the heart, kidneys, and metabolism work together, shapes outcomes for the baby, not only the mother.
Conditions like obesity, diabetes, and HDP before or during pregnancy can raise the odds of things like preterm birth, a larger-than-average baby, newborn low blood sugar, or a NICU stay. When two or more conditions occur together, which is increasingly common, their effects can compound rather than simply add up.
There's also research suggesting children born to mothers with these conditions may face a somewhat higher chance of heart or metabolic issues later in life. It's important to read that carefully: these studies show an association, not proof of cause. Genetics, family environment, and shared habits all play a role. This isn't a reason for guilt, it's simply useful context that can help your child's care team down the road.
The encouraging takeaway is that the window for prevention opens long before delivery day, and it can benefit both of you.
So why is this happening? Several things at once
It’s rarely one factor — and most of them are bigger than any individual choice.
We’re navigating a tougher food environment. Food insecurity, inconsistent access to enough nutritious food, has risen sharply among pregnant women over the past decade, and it's linked to poorer cardiometabolic health regardless of body weight. Diets heavy in ultra-processed foods and sodium, and light on whole grains, are associated with higher risk, and those diets often reflect what's affordable and available, not willpower.
Many women are becoming pregnant a little later in life, frequently a thoughtful, positive choice. Because blood pressure and blood sugar issues become more common with age, this naturally adds complexity.
Rates of obesity, chronic hypertension, and diabetes have all climbed over the past few decades across the whole population.
Everyday chemicals are under study. Researchers are exploring whether endocrine-disrupting chemicals in some plastics and packaging affect metabolism. The evidence is still early.
By 2022, more than 6 in 10 women in the U.S. had at least one cardiometabolic risk factor before pregnancy. That's not a story about personal failure, it's a story about a system that makes healthy defaults harder than they should be.
The biggest missed opportunity: before pregnancy for the healthiest pregnancy
Here's what frustrates many of us in cardiology. Despite how common these risk factors have become, only about 1 in 10 women with conditions like obesity or high blood pressure report receiving any counseling before pregnancy. Yet that pre-pregnancy window is one of the best chances we ever get to set the stage for a healthier pregnancy.
The data also shows this burden isn't shared equally. The rise in HDP has been disproportionately greater among Hispanic, Black, and Asian or Pacific Islander women, a reflection of long-standing inequities in maternal health that deserve real, sustained attention, not silence.
What you can actually do
You have more agency here than the headlines suggest. A few steps that genuinely move the needle:
Get a preconception checkup and ask specifically about your blood pressure, blood sugar, weight, and heart health.
Address borderline numbers early. If you have prediabetes, borderline blood pressure, or a weight you'd like to support with, working on it before pregnancy, with your clinician, at your pace, is far easier than during.
Make changes that last, not changes that punish. Choosing whole grains more often and cooking at home a little more can meaningfully support healthier blood pressure and blood sugar over time. Small and sustainable beats are dramatic and short-lived.
Don’t skip postpartum follow-ups. Pregnancy complications are clues about your future heart health.
Carry your history forward. If you have gestational diabetes or HDP, mention it at future visits for the rest of your life. These are lifelong markers of cardiovascular risk, not problems that end at delivery.
Tell your child’s pediatrician about your pregnancy history. No special screening is recommended solely because of it, but it’s valuable context for their long-term care.
The bottom line
Pregnancy is often described as a stress test for the body. It rarely creates heart and metabolic problems, more often, it reveals ones that were quietly developing long before. Today, more pregnancies begin against a backdrop of cardiometabolic risk, which makes modern pregnancy more complex even as fewer women are having babies.
None of this is meant to frighten you. It’s meant to hand you a head start.
The healthiest pregnancy often begins before the first prenatal visit, and it starts with something simple and entirely within reach: knowing your numbers. Whether you're planning a pregnancy now, considering one someday, or supporting someone who is, that first step is the same.
About the author: Dr. Divyanshu Kumar is a guest contributor to the Preventiononly blog. This article was edited by Saneka Chakravarty, MD, FACC, a board-certified cardiologist and the founder of Preventiononly, a membership-based preventive medicine practice focused on cardiovascular-kidney-metabolic (CKM) health.
This article is educational and not a substitute for individualized medical advice. Talk with your own clinician about what’s right for you.
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A related original research paper by the author on this topic is currently pending submission for peer review.
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