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Hypertensive pregnancy is associated with increased maternal cardiovascular risk in later life. A range of cardiovascular adaptations after pregnancy have been reported to partly explain this risk. We used multimodality imaging to identify whether, by midlife, any pregnancy-associated phenotypes were still identifiable and to what extent they could be explained by blood pressure. Participants were identified by review of hospital maternity records 5 to 10 years after pregnancy and invited to a single visit for detailed cardiovascular imaging phenotyping. One hundred seventy-three women (age, 42±5 years, 70 after normotensive and 103 after hypertensive pregnancy) underwent magnetic resonance imaging of the heart and aorta, echocardiography, and vascular assessment, including capillaroscopy. Women with a history of hypertensive pregnancy had a distinct cardiac geometry with higher left ventricular mass index (49.9±7.1 versus 46.0±6.5 g/m 2 ; P =0.001) and ejection fraction (65.6±5.4% versus 63.7±4.3%; P =0.03) but lower global longitudinal strain (-18.31±4.46% versus -19.94±3.59%; P =0.02). Left atrial volume index was also increased (40.4±9.2 versus 37.3±7.3 mL/m 2 ; P =0.03) and E:A reduced (1.34±0.35 versus 1.52±0.45; P =0.003). Aortic compliance (0.240±0.053 versus 0.258±0.063; P =0.046) and functional capillary density (105.4±23.0 versus 115.2±20.9 capillaries/mm 2 ; P =0.01) were reduced. Only differences in functional capillary density, left ventricular mass, and atrial volume indices remained after adjustment for blood pressure ( P &lt;0.01, P =0.01, and P =0.04, respectively). Differences in cardiac structure and geometry, as well as microvascular rarefaction, are evident in midlife after a hypertensive pregnancy, independent of blood pressure. To what extent these phenotypic patterns contribute to cardiovascular disease progression or provide additional measures to improve risk stratification requires further study.

Variations in Cardiovascular Structure, Function, and Geometry in Midlife Associated With a History of Hypertensive Pregnancy