Journal of Primary Care Specialties · Sep 2026
Pregnancy as a Window to Future Chronic Disease: A Systematic Review of the Role of Primary Care in Lifelong Risk Identification and Prevention
By Andonotopo W, Suryawan A, Putra RA et al.
Abstract Pregnancy is increasingly recognized as a window into women’s long-term health, with adverse pregnancy outcomes (APOs) identifying susceptibility to chronic disease years before clinical presentation. This systematic review synthesized evidence linking preeclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, fetal growth restriction, and pregnancy loss with subsequent maternal disease and examined implications for primary care prevention. PubMed/MEDLINE, Scopus, Web of Science, and Embase were searched through April 30, 2026, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 principles. The protocol was developed a priori but was not prospectively registered in the International Prospective Register of Systematic Reviews. Eligible evidence was qualitatively synthesized, and methodological quality and risk of bias were assessed according to study design. Thirty-five studies, including systematic reviews, meta-analyses, cohort studies, reviews, scientific statements, and clinical guidance, were included. Across the evidence base, APOs were consistently associated with higher subsequent risks of cardiovascular disease, chronic hypertension, type 2 diabetes mellitus, metabolic syndrome, chronic kidney disease, stroke, and multimorbidity. Methodological quality was generally acceptable, although heterogeneity in exposure and outcome definitions, follow-up, covariate adjustment, and residual confounding limited causal inference. Shared vascular, metabolic, inflammatory, placental, genetic, behavioral, and social factors may contribute to both pregnancy complications and later disease, suggesting that APOs may reveal preexisting susceptibility as well as participate in longer-term disease pathways. Pregnancy therefore represents an important biological stress test rather than proof of a direct causal pathway. Incorporating obstetric history into primary care may enable earlier risk recognition, targeted surveillance, and preventive intervention, although prospective studies are needed to determine whether pregnancy-informed care improves long-term clinical outcomes.