Adverse Pregnancy Outcomes and Cardiovascular Health Among Offspring in Early Adulthood

Importance Adverse pregnancy outcomes (APOs) confer risk for maternal cardiovascular disease, but the role of APOs in cardiovascular health (CVH) of offspring across the life course is unknown. Objective To examine associations of APO exposure with CVH and early arterial injury among offspring in young adulthood. Design, Setting, and Participants This longitudinal cohort study used data from the Future of Families and Child Well-Being Study and Future of Families—Cardiovascular Health Among Young Adults study, conducted in 20 US cities from February 1998 to September 2000, with follow-up until September 2023. Participants were mother-child dyads enrolled at the child’s birth; offspring were followed up until young adulthood (year 22). Data were analyzed from June 2024 to June 2025. Exposures Hypertensive disorders of pregnancy (HDP), gestational diabetes (GD), and preterm birth (PTB), ascertained by pregnancy medical records. Main Outcomes and Measures Offspring CVH assessed by the American Heart Association’s Life’s Essential 8 (LE8) score, individual clinical cardiovascular risk factors, and arterial injury assessed by carotid ultrasonography at year 22 after birth. Results Among 1333 offspring participants (729 [55%] female; mean [SD] age in early adulthood, 22.4 [0.7] years), 128 (10%) had HDP exposure, 67 (5%) had GD exposure, and 137 (10%) had PTB exposure. In analyses adjusted for sociodemographic factors, HDP exposure was associated with higher body mass index (adjusted β, 2.80; 95% CI, 1.07-4.53), higher diastolic blood pressure (adjusted β, 2.29; 95% CI, 0.17-4.41), and higher glycated hemoglobin (HbA_1c) level (adjusted β, 0.21; 95% CI, 0.02-0.41) in early adulthood. PTB was associated with higher HbA_1c level (adjusted β, 0.29; 95% CI, 0.15-0.43). GD exposure was associated with a lower LE8 blood pressure score (adjusted β, −6.59; 95% CI, −13.95 to −0.16). HDP exposure was associated with higher mean carotid intima-media thickness (adjusted β, 0.02; 95% CI, 0.01-0.03) and lower carotid grayscale median (adjusted β, −3.68; 95% CI, −6.30 to −1.05). Exposure to GD was associated with higher mean carotid intima-media thickness (adjusted β, 0.02; 95% CI, 0.00-0.04). Conclusions and Relevance 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 CVH and arterial injury among offspring in early adulthood. The findings suggest optimizing pregnancy health may support offspring CVH into early adulthood.