Exposure to adverse pregnancy outcomes (APOs) during gestation is associated with suboptimal cardiovascular health (CVH) among offspring in early adulthood, according to a study published online May 14 in JAMA Network Open.
Emily L. Lam, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined associations of APO exposure with CVH and early arterial injury among offspring in young adulthood (mean age, 22.4 years) in a longitudinal cohort study.
The researchers found that 10, 5, and 10 percent of the 1,333 offspring participants had exposure to hypertensive disorders of pregnancy (HDP), gestational diabetes (GD), and preterm birth (PTB), respectively. After adjustment for sociodemographic factors, HDP exposure was associated with higher body mass index, higher diastolic blood pressure, and higher hemoglobin A1c (HbA1c) level in early adulthood (adjusted β, 2.80, 2.29, and 0.21, respectively).
There was an association between PTB and higher HbA1c levels (adjusted β = 0.29). GD exposure was associated with lower Life’s Essential 8 blood pressure scores (adjusted β, −6.59). An association was observed between HDP exposure and higher mean carotid intima-media thickness and lower carotid grayscale median (adjusted βs of 0.02 and −3.68, respectively). Higher mean carotid intima-media thickness was seen in association with exposure to GD (adjusted β, 0.02).
“We must make sure people maintain good health from childhood into young adulthood, so that if or when someone becomes a parent, they pass on the best opportunity for good health to their children,” senior author Nilay S. Shah, M.D., M.P.H., also from the Feinberg School of Medicine, said in a statement.
Black women experience disproportionately higher rates of adverse pregnancy outcomes, including hypertensive disorders of pregnancy, preterm birth, and severe maternal morbidity. These disparities are driven by a complex interplay of factors, including differences in quality of care, the cumulative effects of chronic stress, social determinants of health, and structural inequities within the healthcare system.
The study’s findings suggest that the effects of APOs may extend beyond maternal cardiovascular health and influence the long-term cardiovascular well-being of offspring. If pregnancy complications contribute to early markers of cardiovascular dysfunction in children, existing maternal health inequities could have intergenerational consequences for Black families already disproportionately affected by hypertension, stroke, and heart disease.
For providers, these findings underscore the importance of viewing pregnancy as a critical window into family health rather than an isolated event.
Obstetric history has been recognized as an important component of cardiovascular risk assessment. While APOs are established risk factors for future cardiovascular disease in mothers, emerging evidence suggests they may also identify offspring who could benefit from earlier monitoring and prevention efforts.
Clinicians across specialties should consider routinely documenting a history of pregnancy complications and incorporating those conversations into long-term care planning. Improved communication between obstetric, primary care, pediatric, and cardiology teams may help ensure that families with a history of APOs receive appropriate counseling and follow-up beyond the postpartum period.
As cardio-obstetrics continues to evolve, pregnancy history may offer valuable insights into opportunities for earlier interventions across generations.
Although additional research is needed to clarify how adverse pregnancy outcomes influence cardiovascular trajectories in offspring, the findings highlight potential opportunities for prevention. Pediatricians and primary care clinicians may consider obtaining relevant prenatal histories, particularly among patients with other cardiovascular risk factors.
Early interventions focused on healthy eating patterns, regular physical activity, blood pressure monitoring, and metabolic screening could help address risk before clinically significant disease develops. This approach may be especially meaningful in Black communities, where the burden of cardiovascular disease remains disproportionately high.
Recognizing offspring exposed to APOs as a population that may warrant closer attention could help clinicians shift from reacting to disease to preventing it.
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