Research Summary

Does Cardiovascular Health in Adolescence Forecast Pregnancy Morbidity Decades Later?

Anthony Calabro, MA

Key Highlights

  • Optimal adolescent/young-adult cardiovascular health corresponded to lower risks of gestational diabetes and hypertensive disorders of pregnancy later in life.
  • Poor adolescent cardiovascular health was associated with a higher adjusted risk of gestational diabetes vs optimal cardiovascular health.
  • Gestational diabetes incidence was highest when poor cardiovascular health persisted from adolescence into young adulthood.

In a cohort analysis of 1094 women from the National Longitudinal Study of Adolescent and Adult Health, optimal cardiovascular health in adolescence and young adulthood was associated with lower risks of gestational diabetes and hypertensive disorders of pregnancy in later pregnancies. The highest burden of gestational diabetes occurred among individuals who maintained poor cardiovascular health across both life stages, whereas sustained optimal cardiovascular health conferred the lowest incidence.

Cardiovascular disease is a leading driver of maternal morbidity and mortality in the United States, and pregnancy often reveals latent cardiometabolic risk that may resurface later in life. Because nearly half of pregnancies are unintended and many individuals lack preconception care, adolescence and young adulthood represent pivotal windows for shaping lifelong cardiovascular health behaviors and mitigating intergenerational risk.

Using Add Health waves 1–5, the investigators categorized adolescent and young-adult cardiovascular health with an adapted Life’s Essential 8 (0–100) score, emphasizing behaviors and BMI (clinical measures such as blood pressure, lipids, and glucose were unavailable at the adolescent time points). Participants were included if they reported a birth between waves 3–5 and had no pregestational diabetes or hypertension. Outcomes were self-reported gestational diabetes and hypertensive disorders of pregnancy; associations between adolescent cardiovascular health and outcomes were estimated via log-binomial regression with survey weights, clustering, and adjustment for sociodemographic confounders.

Poor adolescent cardiovascular health was associated with a higher adjusted risk of future gestational diabetes compared with optimal cardiovascular health (ARR, 2.01; 95% CI, 0.96–4.24); intermediate cardiovascular health showed no increased risk (ARR, 1.04; 95% CI, 0.53–2.07). For hypertensive disorders of pregnancy, adjusted risks were not statistically elevated for poor (ARR, 1.22; 95% CI, 0.74–2.01) or intermediate cardiovascular health (ARR, 1.43; 95% CI, 0.93–2.21).

Gestational diabetes incidence was 28.5% among those with poor cardiovascular health in both adolescence and young adulthood compared with 9.6% for sustained intermediate cardiovascular health and 4.7% for sustained optimal cardiovascular health.

Transitioning from poor to intermediate cardiovascular health was associated with a lower gestational diabetes incidence (14.7%) than remaining poor (28.5%); poor-to-optimal still had a high gestational diabetes incidence (24.9%). For hypertensive disorders of pregnancy, the lowest incidence was observed with sustained optimal cardiovascular health (14.8%). Population-attributable modeling suggested that preventing poor or intermediate adolescent cardiovascular health could reduce gestational diabetes from 9.3% to 7.6% and hypertensive disorders of pregnancy from 24.5% to 18.3%.

This study had limitations including a reliance on self-reported pregnancy complications, an adolescent cardiovascular health construct that omitted clinical components (blood pressure, lipids, glucose), potential misclassification between survey waves, small subgroup sizes for some trajectory comparisons, and adjustment constraints (eg, insurance status only in young adulthood).

“In this cohort study, the incidence of gestational diabetes was higher among those with poor cardiovascular health in adolescence and young adulthood,” the researchers concluded. “Achieving optimal cardiovascular health in adolescence may reduce the risk of gestational diabetes in adulthood.”

Reference
McCarthy KJ, Ng A, Boychuk NA, et al. Adolescent Cardiovascular Risk Trajectories and Later-Life Maternal Morbidity. JAMA Netw Open. 2025;8(10):e2536095. doi:10.1001/jamanetworkopen.2025.36095