Body Changes After Pregnancy: What Lasts and What to Check

Some changes from pregnancy last, like stretch marks that fade but never fully go, and feet that may stay longer and flatter. The one that matters most is invisible, since high blood pressure or gestational diabetes in pregnancy raises your later risk of heart disease. Gestational diabetes also raises your risk of type 2 diabetes.

Maybe your youngest is in kindergarten by now. Your old shoes pinch, a sneeze still means crossing your legs, and the glucose test from that pregnancy is a blur. The doctor you see today may not even know it happened.

What settles in the first year (shedding, periods, broken sleep) is in the month-by-month guide to the first year after baby. Everything below is about what's still there after it.

Which Body Changes After Pregnancy Last for Years?

Stretch marks and bladder leaks have the best evidence for lasting, and feet changes look lasting too. Many of the lasting changes are harmless, and the ones worth acting on are mostly ones you can't see in a mirror.

• Likely to last: stretch marks, and probably longer feet with lower arches.
• Can last, and worth treating: melasma, and bladder leaks that started soon after birth.
• Not backed by the evidence: a metabolism that's slower for good.
• Invisible, and worth checking for years: blood pressure, blood sugar and thyroid after a pregnancy complication.

Why Your Shoes Still Don't Fit

A University of Iowa study measured the feet of 49 women in early pregnancy and again about five months after birth. Their arches dropped, and feet got longer and wider for about 60 to 70 percent of the women. The extra length was about 0.1 to 0.4 inch (2 to 10 mm).

The researchers called the change permanent, and first pregnancies seemed to account for most of it. Their last measurement was five months after birth, though, so "permanent" is their reading of the data rather than something they tracked for years. If your shoes haven't fit since your first baby, buy for the feet you have now.

Do Stretch Marks and Melasma Go Away?

Stretch marks fade, but they stay. When they first appear, they can be red, purple, pink, reddish-brown or dark brown, depending on your skin color. Over time the color fades and the bands sink beneath the skin.

The American Academy of Dermatology says stretch marks are permanent, like any scar, and that treatment seems to have little effect on mature ones. So a cream on three-year-old marks is unlikely to do much. Creams work best on early marks. If you're pregnant again or breastfeeding, check with your doctor before treating them.

Melasma is different, because what you do now still changes it. The AAD's advice is a tinted sunscreen that contains iron oxide with SPF 30 or higher.

The tint matters. The AAD says visible light has been shown to worsen melasma, especially for people with darker skin tones. The guide to treating melasma goes through the options beyond sunscreen.

Does Pregnancy Change Your Brain for Good?

One study found changes that lasted at least two years. Researchers scanned first-time mothers and fathers before and after pregnancy, and gray matter shrank in brain regions involved in social cognition. Social cognition is how you read and understand other people.

The changes showed up in the mothers only, and a follow-up found them still there two years after pregnancy. They overlapped with the areas that responded to the women's own babies, and they predicted measures of attachment to the baby. That's one study of first-time parents.

Does Pregnancy Slow Your Metabolism?

There's no good evidence that it does. A 2021 study in Science pooled energy measurements from people aged 8 days to 95 years. Adjusted for body size, daily energy use stayed stable from 20 to 60, and the authors say this held even during pregnancy.

It pooled measurements from people of different ages. Its pregnancy data only ran to about six months after birth, so it didn't follow women for years. It gives no backing to a lasting slowdown, though. If you feel flat years later, sleep, iron, thyroid and mood are each checkable and treatable.

The Pregnancy Complications That Matter Years Later

About 10% to 15% of pregnant women have what the American Heart Association calls an adverse pregnancy outcome. In 2021 it named six pregnancy complications linked to heart disease later in life:

• High blood pressure in pregnancy. Gestational hypertension raises later cardiovascular risk by 67% and the odds of stroke by 83%. Preeclampsia comes with a 2.7 times higher risk.
• Gestational diabetes. It raises cardiovascular risk by 68% and the risk of type 2 diabetes tenfold.
• Preterm delivery, which about doubles the risk.
• Placental abruption, linked to an 82% higher risk.
• Pregnancy loss. Stillbirth is linked to about double the risk.
• A baby born small for gestational age.

Those are relative numbers. They mean your risk is higher than it would otherwise be, not that heart disease is likely. The AHA also says Black, Asian and Hispanic women have more of these complications, and more heart risk factors, than white women.

Gestational diabetes deserves its own line. The CDC says about half of women with gestational diabetes go on to develop type 2 diabetes. Its advice is to ask your doctor how often to have your blood sugar checked.

Why Your Doctor Might Not Know

Your pregnancy records may sit with an obstetric team your current doctor never talks to. The AHA asked for better handoffs between obstetric and primary care clinicians, and for doctors to take a short pregnancy history. For women with these complications, it suggests close blood pressure monitoring and screening for type 2 diabetes and cholesterol.

That handoff is something you can do yourself. At your next checkup, tell the doctor:

• which complications you had, and in which pregnancy
• whether your thyroid was off after a birth
• that you'd like to know how often to check your blood pressure, blood sugar and cholesterol, given that history

What If My Thyroid Went Off After Birth?

Postpartum thyroiditis affects about 5% to 10% of women in the US. The American Thyroid Association says most get normal thyroid function back within 12 to 18 months of symptoms starting. But about 20% of those who go into a hypothyroid phase will remain hypothyroid.

It also comes back in about 20% of women with later pregnancies. If it happened to you, ask how often your thyroid should be rechecked, and mention it before trying for another baby.

Is It Normal to Still Leak Years After Birth?

It's common, but it's treatable. A study of women who gave birth in Aberdeen, Birmingham and Dunedin followed them for 12 years, and 3,763 replied at the end. Of those who leaked urine three months after birth, 76.4% still did 12 years later. That's about three in four.

So leaks that started after a birth usually don't clear up just by waiting. The guide to your pelvic floor after pregnancy covers what helps and who to ask. A bulge, a heavy dragging feeling or painful sex also deserves a doctor visit, however long ago the birth was.

When Postpartum Depression Lasts Past the First Year

For some women it does. An NIH study followed about 5,000 mothers in New York State for three years after birth. About 1 in 4 had high levels of depressive symptoms at some point in those three years.

Women with mood disorders or gestational diabetes were more likely to have high symptoms that lasted through the study. The American Academy of Pediatrics recommends screening mothers at one, two, four and six months after birth. The researchers say screening for at least two years after birth may help.

The study used a short questionnaire, not a diagnosis, but feeling low at year two is not something to wait out. If you're unsure what you're dealing with, how postpartum anxiety differs from depression can help you put words to it.

When to See a Doctor

Book a visit if you had any of the six complications and nobody has checked your blood pressure or blood sugar since. Also go if leaks, heaviness or painful sex haven't improved, or if you've felt low, numb or anxious for weeks.

Chest pain, sudden shortness of breath, a drooping face, trouble speaking or sudden weakness on one side of your body need emergency help. Call 911 (999 in the UK) or go to the nearest ER.

If you have thoughts of harming yourself, call or text 988 any time in the US and Canada. That reaches the 988 Suicide & Crisis Lifeline in the US and the 9-8-8 Suicide Crisis Helpline in Canada. If your life is at risk or you can't keep yourself safe, call 911 or go to the nearest ER.

In the UK, call Samaritans free on 116 123, any time, or 999 in an emergency. Anywhere else, call your local emergency number.

In the US, the National Maternal Mental Health Hotline is for people who are pregnant or have recently had a baby. Call or text 1-833-852-6262 (1-833-TLC-MAMA), or use its online chat, any time, in English or Spanish. It's free and confidential.

Frequently Asked Questions

Does Pregnancy Permanently Change Your Body?

Some changes last. Feet can stay longer with lower arches, stretch marks fade but stay, and one study found brain changes that lasted at least two years. A pregnancy complication also leaves a higher risk of heart disease that's worth checking for years.

Can Stretch Marks Go Away Years After Pregnancy?

No. The AAD says stretch marks are permanent, though their color fades and they become less noticeable. Treatment seems to have little effect on mature marks, so a dermatologist is the place to ask if they bother you.

Does Breastfeeding Lower Heart Risk After a Complicated Pregnancy?

It may. The American Heart Association says breastfeeding may lower the later risk of heart disease and of metabolic problems such as type 2 diabetes. It doesn't replace regular blood pressure and blood sugar checks.