April 2026
Circulating biomarkers in pregnancy may indicate long-term CVD risk
By Rebecca Jenkins
Two circulating biomarkers measured during late pregnancy are independently associated with long-term cardiovascular disease (CVD) risk in women, a prospective cohort study suggests.
Using a Danish population-based registry of 38,455 pregnancies, researchers aimed to assess the predictive value of the pregnancy-specific biomarkers soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor and the cardiovascular-specific biomarkers high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide.
Of the entire cohort, 2056 women had biomarkers measured during pregnancy at week 12 or week 29, researchers reported in JAMA Cardiology. Over a median follow up of 11.9 years, 28 of these 2056 women developed CVD.
Adverse pregnancy outcomes occurred in 319 women (15.5%), including fetal growth restriction (4.7%), preterm delivery (4.9%) and stillbirth (0.4%). Meanwhile, hypertensive disorders of pregnancy (HDP) were observed in 193 women (9.4%).
Maternal age, HDP and third-trimester concentrations of hs-cTnI and sFlt-1 were each independently associated with higher long-term CVD risk, researchers reported.
‘A combined model including age and sFlt-1 measured at week 29 improved discrimination for CVD compared with a base model of age alone, whereas a clinical model consisting of age, systolic blood pressure and non-high-density lipoprotein cholesterol did not,’ they added.
The results were consistent in women without prior hypertension or HDP and in nulliparous women.
Professor Amanda Henry, Program Head, Women’s Health, The George Institute for Global Health, and Professor of Obstetrics, UNSW Medicine and Health, UNSW Sydney, said the findings were promising, but further research was needed to confirm the observed associations.
‘It is encouraging to see work on ways to better predict CVD after HDP and other pregnancy complications, as existing CVD risk models poorly predict high risk in younger women,’ Professor Henry told Medicine Today.
Of the promising biomarkers, Professor Henry noted that hs-cTnI was a marker of CVD risk in the general population, whereas sFlt-1 had antiangiogenic properties and was a pre-eclampsia biomarker.
‘However, it is also plausible that sFlt-1 could serve as a longer-term signal regarding endothelial function and therefore CVD risk,’ Professor Henry said.
It was often used at 12 weeks for pre-eclampsia prediction and sometimes used in later gestation to rule out pre-eclampsia, as part of the sFlt-1/placental growth factor ratio.
‘However, it is not used routinely in later gestation, which is when it seemed to have some CVD predictive utility in the current study, so much larger studies are needed across diverse global populations to assess utility,’ she added.
Nonetheless, Professor Henry strongly backed the authors’ conclusions that pregnancy offered a crucial window into a woman’s long-term health, including CVD risk.
‘CVD risk factors that a woman brings into pregnancy such as above-normal blood pressure and body mass index increase the chance of adverse pregnancy outcomes such as HDP and gestational diabetes,’ Professor Henry said.
‘And pregnancy complications such as HDP and gestational diabetes in turn increase a variety of long-term cardiovascular, kidney and metabolic disease risks.’
Although there was more still to be known around CVD prevention after pregnancy complications, Professor Henry said there were ways clinicians could support women postpartum.
For guidance on follow up after HDP and long-term CVD prevention, Professor Henry recommended the NHMRC-endorsed 2023 SOMANZ Hypertension in Pregnancy Guidelines (https://somanz.org/hypertension-in-pregnancy-guideline-2023/) which included a chapter on postpartum care with a checklist for clinicians (https://www.somanz.org/content/uploads/2024/01/8.1-Clinician-check-list-for-long-term-post-partum-care.pdf).