Introduction

Ischaemic heart disease results in 7.5 million deaths worldwide and remains the leading cause of death in women.1 Additionally, pregnancy-related maternal morbidity in the world has increased nearly 200% between 1993 and 2014 in the USA.2 Adverse pregnancy outcomes (APOs), which include hypertensive disorders of pregnancy (HDPs), such as pre-eclampsia, gestational diabetes mellitus (GDM), preterm delivery and small-for-gestational-age infants, are common and occur in 17–20% of all pregnancies in the USA.3 Mounting evidence over the past several decades has demonstrated that a history of APOs robustly predicts later-life risk of cardiovascular disease (CVD), including coronary artery disease (CAD) and heart failure, in affected individuals.4 5 APOs and CVD share similar risk factors, including obesity, hypertension, metabolic syndrome, race and suboptimal social determinants of health (SDOHs).6

The American Heart Association’s (AHA) Life’s Essential 8 framework redefines cardiovascular health (CVH) and offers tools that clinicians should use to promote a healthy lifestyle to optimise cardiometabolic status throughout the pregnancy continuum.7 By increasing awareness of sex-specific risk factors, like APOs, across the different subgroups of women and screening these women for obstetric complications, we can identify women earlier who are at risk of future CVD. In doing so, we can initiate lifestyle interventions and, where appropriate, medical therapies sooner to prevent CAD.8

The burden of cardiovascular risk factors in pregnancy-capable populations needs better management and optimisation. Although the prevalence of ischaemic heart disease is increasing worldwide, the historical underestimation of CAD in women, combined …