Women who experience complications during pregnancy may be at greater risk of dying from heart disease later in life than women with uncomplicated pregnancies, according to new research in the American Heart Association‘s journal Circulation.

Cardiovascular diseases (CVD) is the No. 1 killer of American women. According to the American Heart Association, 399,503 women died of CVD in 2013. CVD is also the leading cause of death among American men.

Researchers analyzed data from the Public Health Institute’s Child Health and Development Studies (CHDS), which enrolled 15,528 pregnant women in the Oakland, Calif., metropolitan area from 1959 to 1967. As of 2011, 368 women (average age 66) had died of CVD. Researchers confirmed several pregnancy complications associated with CVD reported in other studies (pre-eclampsia, pre-term delivery and small-for-gestational-age delivery) but here also found that preeclampsia in early pregnancy strongly predicts premature CVD death before age 60.

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