Long-term sequelae of adverse pregnancy outcomes

A growing body of literature highlights the importance of recognizing adverse pregnancy outcomes (APOs) as cardiovascular risk factors when risk stratifying women for cardiovascular disease (CVD). We conducted a comprehensive review of the long term cardiovascular consequences associated with APOs including hypertensive disorders of pregnancy (HDP), preterm delivery, gestational diabetes (GDM), low birth weight and fetal growth restriction during pregnancy using electronic databases, PubMed and the Cochrane Library. Women with pregnancies complicated by HDP, preterm birth, and low birth weight are at higher risk of developing CVD than were women without APOs in the years following pregnancy. Among women with a history of multiple APOs, HDP and GDM are independent risk factors for atherosclerotic CVD. The pathophysiology leading to CVD is multifactorial, and includes both physiologic and environmental factors. APOs should be accounted for in a women's CVD risk assessment and stratification as recommended by prevention guidelines. Further research is needed to determine the underlying mechanisms that lead to the increased risk of CVD in women with APOs.