Cardiovascular Risk Assessment in Young Women After Index Pregnancy With and Without Placental Complications

Cardiovascular diseases (CVD) are the leading cause of death among women, particularly non-obstructive myocardial infarction, heart failure, and stroke. However, neither women themselves nor, often, their physicians are fully aware of this reality. This lack of awareness is partly due to gender-related myths and biases that have led to insufficient study of the specific causes and risk factors that affect women's cardiovascular systems. Traditionally, it has been assumed that cardiovascular risk mechanisms, prediction, diagnosis, and treatment are the same in men and women. Today, it is known that this is not true: while the severity and mortality due to cardiovascular disease have decreased in men, they continue to rise and remain more severe among women. Reproductive history and hormonal influence play a decisive role in modulating cardiovascular risk in women. Experiencing complications during pregnancy - such as preeclampsia (a hypertensive disorder caused by abnormal placental function), preterm delivery, or the birth of a low-weight infant - increases the risk of cardiovascular complications up to sevenfold later in life, compared with women who had normal pregnancies. This is explained by the fact that the cardiovascular system undergoes major adaptive changes during pregnancy; in complicated pregnancies, these adaptations fail to occur properly, resulting in cardiovascular stress and damage. Among the objectives of this project, the investigators also aim to evaluate other risk factors such as lifestyle and external influences like exposure to environmental pollutants, which may further contribute to cardiovascular vulnerability. Pregnancy represents a critical window of susceptibility - as seen in other conditions such as COVID-19 - during which these environmental and biological impacts on the cardiovascular system are amplified. In this project, the aim is to investigate how all these factors determine cardiovascular health in a cohort of 1,800 mothers, assessed 3 to 6 years after childbirth. The investigators will also examine how postnatal lifestyle and self-care behaviors may either mitigate or exacerbate this imprint. Women often prioritize their families' needs over their own, which can make it difficult to maintain healthy habits that reduce cardiovascular risk. Moreover, the investigators will study how environmental exposures influence maternal health and explore potential predictive and preventive strategies. The goal is to develop an easy-to-use algorithm or test - ideally in the form of a mobile application - to help women and their physicians assess cardiovascular risk. Although predictive algorithms for cardiovascular health already exist, they have mostly been developed in predominantly male or older populations, and none have considered pregnancy-related factors or environmental exposures, both of which are key determinants of women's cardiovascular health. To date, preventive cardiovascular strategies have not been specifically designed for women, and even less so for recently postpartum women. Existing tools have not been adapted for this population. This project brings together obstetricians and cardiologists, as well as midwives and primary care physicians - the healthcare professionals primarily responsible for women's health and well-being. The investigators believe that this multidisciplinary approach is crucial to anticipate cardiovascular disease and implement truly preventive strategies. All study findings will be disseminated through educational sessions for healthcare professionals, new clinical tools and practices to improve patient satisfaction, audiovisual materials for better maternal health communication, and through professional societies (such as SEGO, SEC, SEAP, SEM, etc.). Results will also be published in open-access scientific journals and shared via public outreach, including media coverage, conferences in hospitals and community centers, social media (@DonaSantPau), and the institutional website (http://www.santpau.cat/web/public/go-inici ). The active participation of women in this study will also allow the creation of discussion and advocacy groups among participants, supporting dissemination through social media, online platforms (https://inatal.org), and patient associations (such as El parto es nuestro), as well as newspapers, radio, and television.