Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, have been associated with elevated blood pressure and higher risk of hypertension in offspring.¹ Lam et al² extended such observations to quantify the associations between in utero exposure to adverse pregnancy outcomes, including HDPs, and a comprehensive suite of cardiovascular health (CVH) measures in offspring as young adults. Within the Future of Families—Cardiovascular Health Among Young Adults (FF-CHAYA) study, investigators evaluated offspring for 20 years or longer after the original cohort enrollment at birth and linked their current CVH to information obtained from maternal delivery records and baseline questionnaires.³ In the analysis by Lam et al,² the offspring’s CVH measures, not surprisingly, were associated with exposures to HDP and other adverse pregnancy outcomes. Adult offspring born to mothers who experienced HDP had an increase in mean diastolic blood pressure by 2.29 mm Hg (95% CI, 0.17-4.41 mm Hg) at age 22 years, among other cardiometabolic risk factors, such as an increase of 2.80 (95% CI, 1.07-4.53) in mean body mass index (calculated as weight in kilograms divided by height in meters squared) and 0.21 (95% CI, 0.02-0.41) percentage points in mean glycated hemoglobin level. Additionally, HDP exposure was associated with an increase of 0.02 mm (95% CI, 0.01-0.03 mm) in mean carotid intima-media thickness and a reduction of the mean carotid grayscale median by 3.68 (95% CI, 6.30-1.05), which are established objective measures of arterial injury. Gestational diabetes (GD) and preterm birth were also associated with blood pressure and vascular stiffness measures, although these estimates were imprecise and less consistent than those for HDP. [JAMA Network] 

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