Abstract Body (Do not enter title and authors here): Introduction: Adverse pregnancy outcomes (APOs) increase the risk for maternal cardiovascular disease, but the effect of APO exposure in utero on offspring cardiovascular health (CVH) across the life course remains unclear.

Research Question: What are the associations of in utero exposures to hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and preterm birth (PTB) with offspring CVH and early arterial injury in early adulthood?

Methods: In the Future of Families-Cardiovascular Health Among Young Adults prospective longitudinal observational cohort (1998-2023) that enrolled mother-child dyads at the time of child’s birth from 20 U.S. sites, with offspring followed through early adulthood, we evaluated in utero exposures to HDP, GDM, PTB as assessed by maternal health records. We evaluated associations of APOs with offspring individual clinical cardiovascular risk factors, composite CVH by American Heart Association Life’s Essential 8 score, and arterial injury measures by carotid ultrasound in early adulthood, using multivariable-adjusted linear regression.

Results: Among 1,140 offspring participants (mean age 22.4 years at follow-up, 55% female), 51% were non-Hispanic Black, 27% Hispanic, and 21% non-Hispanic White. The sample included 6.9% with HDP exposure, 3.5% with GDM exposure, and 7.7% with PTB. In adjusted analyses (Table), exposure to HDP was associated with higher body mass index (β 3.1 kg/m2 [1.2, 5.0]), higher diastolic blood pressure (β 2.9 mmHg [0.59, 5.2]), and higher hemoglobin A1c (β 0.2% [0.0004, 0.3]), as well as higher likelihood of moderate CVH vs. high CVH (OR 2.43 [95% CI 1.07, 5.51]), in early adulthood. Additionally, exposure to HDP was associated with higher mean carotid intima-media thickness (β 0.025 mm [0.012, 0.039]), and lower carotid grayscale median (β -3.9 [95% CI -6.9, -0.9]) by ultrasound, after accounting for cardiovascular risk factor burden. In secondary analysis, these associations were independent of restricted or excessive fetal growth (not shown). There were no associations of GDM exposure or PTB with offspring CVH or arterial injury in young adulthood.

Conclusions: HDP exposure was associated with suboptimal CVH and early arterial injury in early adulthood. Peripartum interventions to support blood pressure control may promote offspring CVH across the life course.