Maternal Cardiovascular Health and Pregnancy Complications

Maternal cardiovascular health and pregnancy complications are intertwined through shared pathophysiological pathways and long‐term risk trajectories. Disorders such as hypertensive disorders of pregnancy (including gestational hypertension and pre-eclampsia), gestational diabetes and extremes of foetal growth (small or large for gestational age) not only complicate the perinatal period but also herald future cardiovascular disease in the mother. Pre-eclampsia and gestational hypertension reflect underlying endothelial dysfunction and heightened inflammatory tone, while gestational diabetes unmasks metabolic susceptibility that may progress to type 2 diabetes. Preterm delivery and abnormal birthweight signal divergent maternal risk profiles, with small-for-gestational-age offspring often indicating vascular insufficiency and large-for-gestational-age offspring reflecting maternal dysmetabolism. Recognition of these pregnancy events as early indicators allows targeted monitoring, risk stratification and prevention strategies to reduce long‐term morbidity and mortality among women worldwide.

Research from Nature Portfolio

Life‐course trajectories of cardiovascular risk factors have been characterised by linking population‐based biobank data with birth registries. Mothers of small-for-gestational-age offspring exhibited persistently higher systolic and diastolic blood pressure across their adult life, yet lower measures of adiposity, compared with those whose infants were appropriate for gestational age. In contrast, mothers of large-for-gestational-age offspring carried greater adiposity, higher non-HDL cholesterol, elevated triglycerides and increased non-fasting glucose levels. These divergent profiles were evident prior to first pregnancy and remained stable into later life, suggesting that foetal growth extremes reflect distinct maternal vascular versus metabolic phenotypes. This insight offers a framework for life-stage-specific prevention, targeting blood pressure control in one group and metabolic modulation in the other.

Maternal Cardiovascular Health and Pregnancy Complications publication trend

The graph below shows the total number of articles in maternal cardiovascular health and pregnancy complications across all publications each year (not limited to Nature Index journals).

Technical terms

Pre-eclampsia: A hypertensive disorder of pregnancy marked by elevated blood pressure and proteinuria after 20 weeks’ gestation, reflecting systemic endothelial dysfunction.

Hypertensive disorders of pregnancy (HDP): A spectrum including gestational hypertension and pre-eclampsia, characterised by new-onset high blood pressure during pregnancy.

Small for gestational age (SGA): Infants whose birthweight falls below the 10th percentile for gestational age, often indicating placental insufficiency.

Large for gestational age (LGA): Infants whose birthweight exceeds the 90th percentile for gestational age, frequently associated with maternal hyperglycaemia or obesity.

Gestational diabetes mellitus (GDM): Glucose intolerance first recognised during pregnancy, linked to both perinatal complications and future maternal type 2 diabetes.

Preterm delivery: Birth occurring before 37 completed weeks of gestation, associated with maternal cardiovascular risk factors such as endothelial dysfunction.

Endothelial dysfunction: Impairment of the blood vessel lining leading to reduced vasodilation, pro-inflammatory and pro-thrombotic states, central to cardiovascular and pregnancy complications.

References

1. Adverse Pregnancy Outcomes and Incident Heart Failure in the Women’s Health Initiative. JAMA Network Open (2021).
2. First Trimester Prediction of Preterm Delivery in the Absence of Other Pregnancy-Related Complications Using Cardiovascular-Disease Associated MicroRNA Biomarkers. International Journal of Molecular Sciences (2022).
3. Life Course Trajectories of Maternal Cardiovascular Risk Factors according to Offspring Birthweight: The HUNT Study. Scientific Reports (2020).
4. Update on sex specific risk factors in cardiovascular disease. Frontiers in Cardiovascular Medicine (2024).