The Association of Adverse Pregnancy Outcomes and Cardiovascular Disease: Current Knowledge and Future Directions

Adverse pregnancy outcomes are associated with increased risk for future cardiovascular disease. The goal of this review is to share what is currently known about the increased risk and to identify areas for future research. Severe studies have identified a strong association between adverse pregnancy outcomes and cardiovascular disease such as heart failure, valvular disease, ischemic heart disease, stroke, hypertension, and metabolic syndrome. The recognition of this increased risk is reflected in recent changes in prevention guidelines. The guidelines now recognize sex-specific risks such as preeclampsia and preterm delivery and recommend incorporating a pregnancy history to identify them earlier. However, no robust risk prediction tools incorporating these pregnancy risk factors have been developed and validated. While smaller clinical trials have been performed in reducing cardiovascular risk factors in the postpartum timeframe, there remains a paucity of large-scale randomized clinical trials that continue to show a risk reduction in these women. While there is increasing recognition of the long-term cardiovascular risks associated with adverse pregnancy outcomes, there remains a need for interventional studies aimed at reducing this risk and for incorporation of pregnancy risk factors into traditional cardiovascular risk prediction tools.