Pregnancy as a Window for Hypertension and Cardiovascular Prevention in Women: A Life-Course Perspective Based on the 2025 ESC Guidelines

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Abstract
The 2025 European Society of Cardiology (ESC) Guidelines on cardiovascular disease in pregnancy introduce a life-course approach to cardiovascular prevention, extending risk assessment and management from preconception through the postpartum period. Beyond the management of established cardiovascular disease, the guidelines emphasize the importance of identifying modifiable risk factors and pregnancy-related complications as early markers of future cardiovascular risk. This narrative mini-review provides a prevention-oriented interpretation of the 2025 ESC Guidelines, focusing on their implications for hypertension prevention and long-term cardiovascular health in women. Pregnancy is increasingly recognized as a biological stress test capable of unmasking latent cardiometabolic and vascular vulnerability, while adverse pregnancy outcomes, including preeclampsia, gestational hypertension, gestational diabetes, fetal growth restriction, and preterm delivery, represent important predictors of future hypertension and cardiovascular disease. Particular emphasis is placed on preconception cardiovascular assessment, lifestyle optimization, obesity management, and the cardiovascular implications of assisted reproductive technologies. The Pregnancy Heart Team is discussed as a multidisciplinary model for integrating cardiovascular and obstetric care across the reproductive continuum. In addition, we propose a practical life-course prevention framework incorporating structured postpartum surveillance, blood pressure monitoring, cardiometabolic screening, and long-term follow-up after adverse pregnancy outcomes. By translating contemporary ESC recommendations into a clinically applicable prevention strategy, this review highlights pregnancy as a unique opportunity for early cardiovascular risk identification and implementation of sex-specific preventive interventions aimed at reducing the future burden of hypertension and cardiovascular disease in women.
Funding Information
  • Alma Mater Studiorum - Università di Bologna

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