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The Barker hypothesis postulates that the fetal environment is an important contributor to coronary heart disease and stroke.1 The best known example of this is the inverse association between birthweight and coronary heart disease in adulthood.2 While clearly relating to the long-term health implications for the person whose fetal conditions are under scrutiny, there is an associated relationship of potentially equal importance, that pregnancy has implications for the long-term health of the mother. This idea has wide-reaching significance for the identification of female-specific risk factors for cardiovascular diseases.
Pregnancy can influence future vascular health in at least 2 ways. Complications of pregnancy that associate with increased risk of cardiovascular and cerebrovascular diseases or their risk factors include gestational diabetes, which is a risk factor for subsequent type 2 diabetes3; preeclampsia, a risk factor for subsequent hypertension, stroke, and coronary heart disease4,5; and fetal growth restriction, which is a risk factor for coronary heart disease.5 In each case, the complication of pregnancy is most likely the result of underlying pathophysiologic processes that also …
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