Pre-eclampsia, gestational diabetes, and hypertension during pregnancy can increase a woman’s risk of developing type 2 diabetes up to 18 times.

Women who suffer from pre-eclampsia or gestational hypertension, two common conditions in pregnancy, may be at a higher risk for developing diabetes later in life, according to a recent study of more than one million women published in PLOS Medicine.

The study also showed that when combined with gestational diabetes, a form of diabetes only associated with pregnancy and a known risk factor for type 2 diabetes, these two conditions can increase the risk of future diabetes by 16 to 18 times.

According to the study, high blood pressure and pre-eclampsia (a condition that causes fluid retention and protein in the urine) affect about eight percent of all pregnancies. However, many women with a history of pre-eclampsia or gestational hypertension are never screened for diabetes after they give birth.

Lead study author Denice Feig of the University of Toronto in Canada says she hopes the results of her study will “alert clinicians to screen these women.”

Toronto researchers used a comprehensive Canadian health database to identify women who gave birth in an Ontario hospital between April of 1994 and March of 2008 who had pre-eclampsia, gestational hypertension, or gestational diabetes. Researchers then recorded whether or not these women developed diabetes between 180 days after delivery and March of 2011.

Out of the more than one million pregnant women included in the analysis, 35,000 or about 3.5 percent, with one or more of these conditions developed diabetes during the follow-up period.

Based on these results, the authors concluded that the risk of future diabetes is about two times higher for women with gestational hypertension or pre-eclampsia alone and 13 times higher for women with gestational diabetes.

Researchers also found that when combined with gestational diabetes, the risk of future diabetes was 18.5 times greater for gestational high blood pressure and about 16 times greater for pre-eclampsia.

The incidence of type 2 diabetes in the U.S. is increasing dramatically. And while previous studies have shown that lifestyle changes and therapeutic interventions can help prevent type 2 diabetes in high-risk individuals, identifying and screening at-risk populations should be a priority.

“Women with gestational diabetes seem to be getting the message about their increased risk,” said Feig in an interview with Healthline. “But even they don’t often get screened for diabetes and don’t make lifestyle changes to lower their risk. We, as physicians, need to talk to our patients and make them aware during pregnancy and postpartum.”

Fortunately, several researchers are working on strategies to increase the screening of women postpartum, such as by sending information to their family physicians, Feig said. Researchers are also developing lifestyle interventions that could help halt the progression to diabetes in these women.

After giving birth, women can help lower their risk of developing diabetes by making simple lifestyle changes, such as maintaining a healthy weight, eating well, and getting regular exercise, Feig said.