Adverse pregnancy outcomes may provide insight into future cardiovascular risk in women, but their independent contribution and predictive utility remain uncertain. A prospective cohort analysis from the Nurses’ Health Study II published in Hypertension evaluated associations between adverse pregnancy outcomes (APOs) and long-term cardiovascular disease (CVD) risk among 59,154 parous women.

Participants reported a lifetime history of APOs, including gestational diabetes mellitus (GDM), gestational hypertension (GH), preeclampsia, preterm delivery, and low birthweight. Cardiovascular events, including myocardial infarction, stroke, and coronary revascularization, were identified through June 2017. Cox proportional hazards models were used to estimate associations and to examine the extent to which subsequent hypertension, diabetes, and hypercholesterolemia attenuated these relationships.

Each APO was associated with higher long-term CVD risk. After adjustment for co-occurring APOs, only GH (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.36-1.92) and preeclampsia (HR, 1.31; 95% CI, 1.11-1.55) remained independently associated. Postpregnancy hypertension, diabetes, and hypercholesterolemia jointly accounted for 58.4% (95% CI, 38.7%–75.8%) attenuation of the association between APOs in the first pregnancy and later CVD.

In predictive analyses, adding APOs to established risk factors resulted in modest improvement in discrimination and slight improvement in risk reclassification. These findings indicate that APOs are associated with long-term CVD risk, with attenuation after accounting for subsequent cardiometabolic conditions, and limited additional contribution to risk prediction.