Antenatal care as a strategic window for long-term cardiovascular risk assessment

Cardiovascular (CV) disease remains the leading cause of death in women, yet risk is often recognized late. Pregnancy is a physiologically demanding, routinely monitored period with repeated health care contact, standardized clinical assessments and blood-based testing, creating a strategic window to capture early signals of CV vulnerability long before conventional midlife risk assessment. Research has largely focused on hypertensive pregnancy complications, but most future CV events occur in women without such complications. Emerging evidence indicates that blood pressure trajectories, angiogenic and cardiac biomarkers, and routinely assessed metabolic parameters are associated with long-term maternal hypertension, subclinical CV phenotypes, and clinical CV events, even in the absence of overt hypertensive pregnancy complications. This review summarizes data on soluble fms-like tyrosine kinase-1, placental growth factor, natriuretic peptides, cardiac troponins, blood pressure, and the metabolic parameters weight and glycemic status, and discusses limitations of the current evidence base and key priorities for translating pregnancyderived signals into clinically actionable CV risk assessment.