Adverse Pregnancy Outcomes Linked to Poorer Cardiovascular Health, Arterial Injury in Young Adult Offspring

Growing evidence has established that adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy (HDP), gestational diabetes (GD), and preterm birth (PTB), are powerful predictors of future cardiovascular disease (CVD) in mothers.¹

Now, a new longitudinal cohort study published in JAMA Network Open extends this understanding in a critical new direction: the cardiovascular consequences of APO exposure may not be limited to the mother but may reach across generations to affect the heart health of her children well into early adulthood.²

“In this longitudinal cohort study of mother-child dyads enrolled at the child’s birth, exposure to APOs during gestation, particularly HDP, was associated with suboptimal [cardiovascular health] and arterial injury among offspring in early adulthood, wrote the researchers of the study. “The findings suggest optimizing pregnancy health may support offspring [cardiovascular health] into early adulthood.”

The study drew on data from the Future of Families and Child Well-Being Study and its cardiovascular follow-up cohort, enrolling mother-child dyads across 20 US cities between February 1998 and September 2000, with follow-up extending through September 2023. A total of 1333 offspring participants were analyzed in young adulthood at a mean (SD) age of 22.4 (0.7) years. Among them, 10% had been exposed to HDP in utero, 5% to GD, and 10% to PTB exposures. Cardiovascular health was assessed using the American Heart Association's (AHA) Life's Essential 8 (LE8) score, and arterial injury was evaluated through carotid ultrasonography.

Offspring born to mothers with HDP had significantly higher body mass index (adjusted β, 2.80; 95% CI, 1.07-4.53), elevated diastolic blood pressure (adjusted β, 2.29; 95% CI, 0.17-4.41), and higher glycated hemoglobin (HbA_1c) levels (adjusted β, 0.21; 95% CI, 0.02-0.41) in early adulthood compared with unexposed peers. PTB exposure was also independently associated with higher HbA_1c levels (adjusted β, 0.29; 95% CI, 0.15-0.43), suggesting that preterm delivery confers metabolic risk to offspring that persists into the third decade of life. GD exposure, meanwhile, was associated with a lower LE8 blood pressure score (adjusted β, −6.59; 95% CI, −13.95 to −0.16).

Additionally, the study documented measurable subclinical arterial injury in young adults exposed to APOs. HDP exposure was associated with increased mean carotid intima-media thickness (cIMT; adjusted β, 0.02; 95% CI, 0.01-0.03) and reduced carotid grayscale median (adjusted β, −3.68; 95% CI, −6.30 to −1.05), a marker reflective of vascular tissue composition. GD exposure was similarly linked to higher mean cIMT (adjusted β, 0.02; 95% CI, 0.00-0.04). Elevated cIMT in young adults is a recognized early indicator of atherosclerotic disease progression, making these findings particularly consequential for long-term cardiovascular risk prediction.

Contextualizing Within the Broader APO-CVD Landscape

These findings arrive amid a rapidly evolving understanding of how pregnancy complications shape cardiovascular trajectories across the life course. For mothers, APOs, including HDP and GD, are now recognized as independent risk factors for future CVD events, prompting the AHA to incorporate APO history into women's cardiovascular risk evaluation frameworks.¹

The study's findings also carry significance in the context of health equity. The Future of Families cohort overrepresented urban and socioeconomically disadvantaged families, populations already disproportionately affected by both APOs and CVD. Socioeconomic adversity in the perinatal period drives widening disparities in birth outcomes and is linked to downstream cardiovascular risk, underscoring the compounding cardiovascular burden faced by vulnerable communities across generations.³

Future research should examine whether early interventions in APO-exposed offspring, whether lifestyle-based or pharmacological, can attenuate the arterial changes and cardiometabolic risk factors observed in this study, according to the researchers.¹ Identifying the critical windows and mediating mechanisms will be essential for translating these findings into actionable prevention strategies.

References

1. Mehta LS, Warners CA, Bradley E, et al. Cardiovascular considerations in caring for pregnant patients: a scientific statement from the American Heart Association. AHA. May 20, 2024. Accessed May 14, 2026. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000772

2. Lam EL, Gauen AM, Khan SS, et al. Adverse pregnancy outcomes and cardiovascular health among offspring in early adulthood. JAMA Netw Open. 2026;9(5):e266783. doi:10.1001/jamanetworkopen.2026.6783

3. Shaw ML. Income inequality fuels worsening birth outcomes. AJMC^®. March 2, 2026. Accessed May 14, 2026. https://www.ajmc.com/view/income-inequality-fuels-worsening-birth-outcomes