Cardiometabolic Health in Pregnancy: Prevention, Management, and Long-Term Implications

Cardiometabolic health across the reproductive lifespan is a critical determinant of short-term pregnancy outcomes and long-term cardiovascular risk for both mother and offspring. Pregnancy serves as a unique physiological stress test and a key opportunity for primordial and primary prevention. Cardiometabolic risk factors-including hypertension, dyslipidemia, obesity, and hyperglycemia-are strongly associated with adverse pregnancy outcomes, such as hypertensive disorders of pregnancy and gestational diabetes, which confer substantial lifelong cardiovascular risk. This review provides a clinically actionable framework for optimizing cardiometabolic health before, during, and after pregnancy. We highlight evidence-based strategies for risk factor modification, including blood pressure control, glycemic management, lipid optimization, nutrition, physical activity, sleep health, and substance cessation, while addressing physiologic adaptations, therapeutic limitations, and care fragmentation. Emphasis is placed on multidisciplinary, life-course approaches and integration of emerging care models. Bridging gaps across preconception, pregnancy, and postpartum care is essential to improving maternal outcomes and long-term cardiovascular health.