Risks of cardiometabolic diseases in women with history of adverse pregnancy outcomes

Cardiometabolic diseases (CMDs) arise from shared pathophysiological pathways characterized by insulin resistance, dysglycemia, inflammation, adipokine dysregulation, and endothelial dysfunction. Pregnancy represents a natural cardiovascular stress test, involving hemodynamic adaptations such as increased blood volume, reduced vascular resistance, and elevated cardiac output. Adverse pregnancy outcomes (APOs) reflect maladaptive responses to this stress and are strongly associated with future CMDs. These outcomes are linked to an increased incidence of hypertension, ischemic heart disease, and stroke in later life. Proposed underlying mechanisms include impaired cardiac remodeling, chronic inflammation, and persistent dyslipidemia. Despite robust evidence linking APOs to future cardiometabolic risk, current cardiovascular disease (CVD) and diabetes prediction tools systematically overlook pregnancy history, leading to significant underestimation of risk in women. This problem is compounded by suboptimal postpartum screening. This review summarizes evidence supporting the role of APOs as early markers of CMDs. We propose a risk-stratification framework that incorporates APOs into CMDs risk assessment, supported by biomarker profiling, and promotes multidisciplinary postpartum care pathways along with individualized interventions such as dietary and physical activity programs. Future research should focus on developing risk prediction models that include APOs and on evaluating early preventive strategies to mitigate the long-term burden of CMDs in this high-risk population.