A Canada-wide study led by a scientist at The Research Institute of the ɬ Health Centre (The Institute), has developed a new risk score to predict cardiovascular disease after childbirth. Published in , the study draws on national administrative data from nearly two million births between 2008 and 2021.
Cardiovascular disease (CVD) remains a leading cause of death and disability in women. Complications such as preeclampsia and other forms of severe maternal morbidity are risk factors specific to women that predict both short-term and long-term risk for CVD. Yet clinicians lack practical tools to identify which postpartum patients are at highest risk — and who may benefit from closer monitoring or early preventive treatment.
To develop the risk score, the research team analyzed nearly two million deliveries across Canada between 2008 and 2021, following women from six weeks after childbirth for up to 10 years. The model incorporated pregnancy-related factors — including hypertensive disorders, preterm birth and other severe maternal complications — as well as nonpregnancy risk factors such as age, chronic hypertension and diabetes.
“Our goal is to develop a tool that reflects the full clinical picture after pregnancy — not just traditional heart disease risk factors, but also complications that occur during pregnancy itself,” said the study’s first author , a doctoral candidate at ɬ and a trainee under Dr. Dayan’s supervision at The Institute. “By combining these elements, we were able to create a risk score that can help stratify patients into low, moderate and high risk categories, representing a promising first step toward a clinical risk calculator.”
Although only 1.5 percent of women fell into the highest-risk group, their likelihood of CVD hospitalization within one year of delivery was nearly eight times higher than the baseline rate. The model showed similar performance at one, five and 10 years postpartum.
“Pregnancy involves many changes to the cardiovascular system and is now widely understood as a cardiovascular stress test,” said Dr. Dayan. “For some women, complications during pregnancy like preeclampsia or severe obstetric hemorrhage unmask an underlying vulnerability for heart disease.”
Dr. Dayan has secured funding to replicate this model in different cohorts and test a novel statistical approach that accounts for the severity, recurrence and timing of pregnancy conditions – factors often overlooked in traditional prediction models.
“The postpartum period is a critical opportunity to educate and intervene,” said Dr. Dayan. “But we need better tools to guide who requires more intensive follow-up and risk factor management—and who can be reassured about their heart health. This risk score is an important first step to realizing this goal.”
Dr. Dayan’s team has also recently published related findings in , showing that individuals who experience severe maternal morbidity are twice as likely to require high levels of healthcare in the first postpartum year compared with women with healthy pregnancies, including emergency department visits, hospitalizations, and visits with specialist physicians. The population-based study highlights the substantial and ongoing medical needs of women after complicated pregnancies, further underscoring the importance of structured postpartum follow-up and cardiovascular risk assessment.
As founder of the ɬ Health Centre’s postpartum maternal cardiovascular health clinic in 2013, Dr. Dayan recognized a gap in care for women with hypertensive pregnancy disorders – one of the most common and potentially serious pregnancy complications, affecting up to 10 per cent of women.
“The clinical need was clear. One third of women seen in this clinic have an underlying metabolic abnormality identified during their first visit at about 3 to 6 months after delivery. However, it has become evident that we need a more robust and systematic way to quantify risk,” she said. “We hope this work will enable clinicians and their patients to develop tailored, evidence-based strategies to improve heart health based on individual risk.”
These studies were made possible by funding from the Canadian Institutes of Health Research.
About the studies
The study, “Risk Score Development to Predict Postpartum Cardiovascular Disease Incorporating Pregnancy and Nonpregnancy Factors: A Canada-Wide Study,” was authored by Melia Alcantara, Gabriel D. Shapiro, Robert W. Platt, Michal Abrahamowicz, Joel G. Ray, Ugochinyere Vivian Ukah, and Natalie Dayan. It was published in JACC: Advances in February 2026 (Vol. 5, No. 2). DOI:
The study, “Association between severe maternal morbidity and health service use in the first postpartum year: a population-based retrospective cohort study in British Columbia, Canada,” was published in BMJ Open (Vol. 16:e110105), authored by Lauren Tanner, Sarka Lisonkova, Gabriel D. Shapiro, Dimitra Panagiotoglou, Robert W. Platt, Ugochinyere Ukah and Natalie Dayan. DOI: