---
title: "Adverse Pregnancy Outcomes as Predictors of Long-Term Cardiovascular Disease Risk"
id: "pubmed-42669304"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42669304"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42669304/"
doi: "10.1016/S0140-6736(26)01235-3"
published_at: "2026-09-05T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Adverse Pregnancy Outcomes as Predictors of Long-Term Cardiovascular Disease Risk
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42669304
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42669304/)
- **DOI:** [10.1016/S0140-6736(26)01235-3](https://doi.org/10.1016%2FS0140-6736(26)01235-3)
- **Published At:** 2026-09-05T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Pregnancy functions as a physiological stress test that can reveal latent cardiovascular vulnerability; **adverse pregnancy outcomes** (APOs) are markers of higher long-term cardiovascular morbidity and mortality. - Common APOs discussed include **hypertensive disorders of pregnancy (HDP)**, **gestational diabetes**, and **preterm birth** (delivery before 37 weeks' gestation); each is associated with substantially increased long-term cardiovascular risk compared with women without APOs. - The observed excess cardiovascular risk likely reflects a mix of pre-existing cardiometabolic and genetic susceptibility plus pregnancy-related haemodynamic and metabolic stressors that accelerate risk factor trajectories and impair endothelial and microvascular function. - The Review synthesises epidemiological data across major APO phenotypes and highlights emerging evidence that maternal APO history is linked to adverse cardiometabolic trajectories in offspring. - Proposed mechanistic pathways include unmasked pre-existing risk, pregnancy-triggered acceleration of cardiometabolic disease processes, and persistent vascular and metabolic dysfunction after delivery. - Current guidance and consensus-informed recommendations for short-term and long-term follow-up after APOs are summarised, and practical approaches for integrating APO history into cardiovascular risk assessment are proposed. - Key knowledge gaps are identified: uncertainty about optimal follow-up models, limitations of existing risk-stratification tools to account for APOs, and the absence of APO-specific prevention trials. - The authors prioritise mechanistic and implementation research and position APOs as early, sex-specific indicators offering an upstream prevention opportunity to improve cardiovascular outcomes for women.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 30. # Adverse pregnancy outcomes and long-term cardiovascular disease risk [Maria A Pabón](https://pubmed.ncbi.nlm.nih.gov/?term=Pab%C3%B3n+MA&cauthor_id=42669304)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#full-view-affiliation-1 "Heart and Vascular Institute, Mass General Brigham, Boston, MA, USA."), [Graeme Smith](https://pubmed.ncbi.nlm.nih.gov/?term=Smith+G&cauthor_id=42669304)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#full-view-affiliation-2 "Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON, Canada."), [Garima Sharma](https://pubmed.ncbi.nlm.nih.gov/?term=Sharma+G&cauthor_id=42669304)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#full-view-affiliation-3 "Division of Cardiology, Inova Schar Heart and Vascular, Falls Church, VA, USA."), [Janet Catov](https://pubmed.ncbi.nlm.nih.gov/?term=Catov+J&cauthor_id=42669304)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#full-view-affiliation-4 "Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA."), [Adam J Lewandowski](https://pubmed.ncbi.nlm.nih.gov/?term=Lewandowski+AJ&cauthor_id=42669304)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#full-view-affiliation-5 "Nuffield Department of Population Health, University of Oxford, Oxford, UK."), [Sumaiya Adam](https://pubmed.ncbi.nlm.nih.gov/?term=Adam+S&cauthor_id=42669304)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#full-view-affiliation-6 "Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa."), [Michael C Honigberg](https://pubmed.ncbi.nlm.nih.gov/?term=Honigberg+MC&cauthor_id=42669304)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#full-view-affiliation-7 "Heart and Vascular Institute, Mass General Brigham, Boston, MA, USA; Cardiovascular Research Center, and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA. Electronic address: mhonigberg@mgh.harvard.edu."); [Cardiovascular Disease in Pregnancy Writing Group](https://pubmed.ncbi.nlm.nih.gov/?term=Cardiovascular+Disease+in+Pregnancy+Writing+Group%5BCorporate+Author%5D) Affiliations Expand ### Affiliations * 1 Heart and Vascular Institute, Mass General Brigham, Boston, MA, USA. * 2 Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON, Canada. * 3 Division of Cardiology, Inova Schar Heart and Vascular, Falls Church, VA, USA. * 4 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA. * 5 Nuffield Department of Population Health, University of Oxford, Oxford, UK. * 6 Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. * 7 Heart and Vascular Institute, Mass General Brigham, Boston, MA, USA; Cardiovascular Research Center, and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA. Electronic address: mhonigberg@mgh.harvard.edu. * PMID: **42669304** * DOI: [ 10.1016/S0140-6736(26)01235-3 ](https://doi.org/10.1016/s0140-6736\(26\)01235-3) Item in Clipboard Review # Adverse pregnancy outcomes and long-term cardiovascular disease risk Maria A Pabón et al. Lancet. 2026. Show details Display options Display options Format Abstract PubMed PMID Lancet Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Lancet%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Lancet%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42669304/) . 2026 Sep 5;408(10558):952-968. doi: 10.1016/S0140-6736(26)01235-3. Epub 2026 Aug 30. ### Authors [Maria A Pabón](https://pubmed.ncbi.nlm.nih.gov/?term=Pab%C3%B3n+MA&cauthor_id=42669304)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#short-view-affiliation-1 "Heart and Vascular Institute, Mass General Brigham, Boston, MA, USA."), [Graeme Smith](https://pubmed.ncbi.nlm.nih.gov/?term=Smith+G&cauthor_id=42669304)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#short-view-affiliation-2 "Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON, Canada."), [Garima Sharma](https://pubmed.ncbi.nlm.nih.gov/?term=Sharma+G&cauthor_id=42669304)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#short-view-affiliation-3 "Division of Cardiology, Inova Schar Heart and Vascular, Falls Church, VA, USA."), [Janet Catov](https://pubmed.ncbi.nlm.nih.gov/?term=Catov+J&cauthor_id=42669304)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#short-view-affiliation-4 "Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA."), [Adam J Lewandowski](https://pubmed.ncbi.nlm.nih.gov/?term=Lewandowski+AJ&cauthor_id=42669304)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#short-view-affiliation-5 "Nuffield Department of Population Health, University of Oxford, Oxford, UK."), [Sumaiya Adam](https://pubmed.ncbi.nlm.nih.gov/?term=Adam+S&cauthor_id=42669304)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#short-view-affiliation-6 "Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa."), [Michael C Honigberg](https://pubmed.ncbi.nlm.nih.gov/?term=Honigberg+MC&cauthor_id=42669304)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42669304/#short-view-affiliation-7 "Heart and Vascular Institute, Mass General Brigham, Boston, MA, USA; Cardiovascular Research Center, and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA. Electronic address: mhonigberg@mgh.harvard.edu."); [Cardiovascular Disease in Pregnancy Writing Group](https://pubmed.ncbi.nlm.nih.gov/?term=Cardiovascular+Disease+in+Pregnancy+Writing+Group%5BCorporate+Author%5D) ### Affiliations * 1 Heart and Vascular Institute, Mass General Brigham, Boston, MA, USA. * 2 Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON, Canada. * 3 Division of Cardiology, Inova Schar Heart and Vascular, Falls Church, VA, USA. * 4 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA. * 5 Nuffield Department of Population Health, University of Oxford, Oxford, UK. * 6 Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. * 7 Heart and Vascular Institute, Mass General Brigham, Boston, MA, USA; Cardiovascular Research Center, and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA. Electronic address: mhonigberg@mgh.harvard.edu. * PMID: **42669304** * DOI: [ 10.1016/S0140-6736(26)01235-3 ](https://doi.org/10.1016/s0140-6736\(26\)01235-3) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Pregnancy provides a unique physiological stress test for the cardiovascular system, during which, adverse pregnancy outcomes (APOs) can unmask latent susceptibility to future disease. Common complications, including hypertensive disorders of pregnancy (HDP), gestational diabetes, and preterm birth (delivery before 37 weeks' gestation), identify women at substantially higher long-term risk of cardiovascular morbidity and mortality compared with women without a history of APOs. These excess risks likely reflect the combined effects of pre-existing cardiometabolic and genetic susceptibility, as well as the haemodynamic and metabolic stressors of pregnancy, heralding accelerated risk factor trajectories, relative impairment in endothelial and microvascular function, and early disease onset. This final Review in the Series extends the focus from cardiovascular disease during pregnancy and HDP to the long-term cardiovascular implications of APOs after delivery. We synthesise epidemiological data quantifying cardiovascular risk across major APO phenotypes and emerging evidence linking maternal APO history with cardiometabolic risk trajectories in offspring. We also delineate putative mechanistic pathways and summarise guidelines and consensus-informed recommendations for short-term and long-term follow-up after APOs. Finally, we propose practical approaches for integrating APO history into cardiovascular disease risk assessment and guideline-directed prevention across the female life course. We highlight key knowledge gaps, including uncertainty about optimal follow-up models, the limitations of current risk-stratification tools, and the absence of APO-specific prevention trials. We also outline priorities for mechanistic and implementation research. Positioning APOs as early, sex-specific indicators of cardiovascular risk offers a key window of opportunity to shift prevention upstream and improve cardiovascular health outcomes for women. Copyright © 2026 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of interests GSm has received honoraria on behalf of Sanofi, Pfizer, and Pharmacosmos, all unrelated to this paper. MCH reports research support from Genentech and site principal investigator work for Novartis, an in-kind study drug from Novartis, and advisory board service for Novartis, all unrelated to this paper. All other authors declare no competing interests. ## Similar articles * [ The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. ](https://pubmed.ncbi.nlm.nih.gov/31111484/) Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, McAuliffe F, da Silva Costa F, von Dadelszen P, McIntyre HD, Kihara AB, Di Renzo GC, Romero R, D'Alton M, Berghella V, Nicolaides KH, Hod M.Poon LC, et al.Int J Gynaecol Obstet. 2019 May;145 Suppl 1(Suppl 1):1-33. doi: 10.1002/ijgo.12802.Int J Gynaecol Obstet. 2019.PMID: 31111484Free PMC article. * [ Life course trajectories of maternal cardiovascular disease risk factors by obstetric history: a UK cohort study using electronic health records. ](https://pubmed.ncbi.nlm.nih.gov/39948598/) Birnie K, Howe LD, Jones T, Madley-Dowd P, Martin FZ, Forbes H, Redaniel MT, Cornish R, Magnus MC, Davies NM, Tilling K, Hughes AD, Lawlor DA, Fraser A.Birnie K, et al.BMC Med. 2025 Feb 14;23(1):91. doi: 10.1186/s12916-025-03937-y.BMC Med. 2025.PMID: 39948598Free PMC article. * [ Pregnancy As a Predictor of Maternal Cardiovascular Disease: The Era of CardioObstetrics. ](https://pubmed.ncbi.nlm.nih.gov/31408425/) Wu P, Mamas MA, Gulati M.Wu P, et al.J Womens Health (Larchmt). 2019 Aug;28(8):1037-1050. doi: 10.1089/jwh.2018.7480.J Womens Health (Larchmt). 2019.PMID: 31408425Review. * [ Adverse Pregnancy Outcomes and Cardiovascular Health Among Offspring in Early Adulthood. ](https://pubmed.ncbi.nlm.nih.gov/42133314/) Lam EL, Gauen AM, Khan SS, Freedman A, Stein JH, Venkatesh KK, Tawa E, Savas H, Goldman N, Notterman DA, Lloyd-Jones DM, Allen NB, Shah NS.Lam EL, et al.JAMA Netw Open. 2026 May 1;9(5):e266783. doi: 10.1001/jamanetworkopen.2026.6783.JAMA Netw Open. 2026.PMID: 42133314Free PMC article. * [ Optimisation of maternal cardiometabolic outcomes after hypertensive disorders of pregnancy. ](https://pubmed.ncbi.nlm.nih.gov/42684842/) Ling HZ, Johnson M.Ling HZ, et al.Womens Health (Lond). 2026 Jan-Dec;22:17455057261484759. doi: 10.1177/17455057261484759. Epub 2026 Sep 2.Womens Health (Lond). 2026.PMID: 42684842Free PMC article.Review. 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