Pregnancy and Long-Term Maternal Cardiovascular Health
In 2011, the American Heart Association added preeclampsia, gestational diabetes mellitus (GDM), and delivery of a growth-restricted child as pregnancy-related risk factors for cardiovascular disease (CVD).1 This move was applauded by the obstetric research community, which for some years had emphasized the importance of pregnancy as a stress test for detecting women at excessive risk for premature CVD.2–4CVD is the leading cause of death for men and women in high-income and most low-to-middle–income countries.5 Globally, coronary artery disease kills more women than men,6 although women develop CVD 10 to 15 years later than men. Women frequently present with unrecognized CVD symptoms and are twice as likely as men to die of a first acute myocardial infarction if <50 years old.7 The preclinical stages of CVD are evident from a young age and are modifiable through control of classic risk factors (insulin resistance/diabetes mellitus, obesity, lack of exercise, tobacco smoking, hypertension, and hyperlipidemia).8,9 In this regard, pregnancy is a window of opportunity for identifying those women with perinatal complications who may benefit from early risk detection and early CVD prevention.In this article, we summarize the associations between pregnancy, placenta-related pregnancy complications, and future maternal CVD. We present established as well as more novel hypotheses, which may explain these epidemiological associations. The interventions that potentially could reduce risks of future CVD are enumerated. To facilitate progress, we suggest methods of harmonizing study designs, long-term follow-ups of pregnancy cohorts and biobanks,