This systematic review and meta-analysis examined the heritability of hypertensive disorders of pregnancy (HDP) and their association with cardiovascular disease in adult offspring. Fifteen studies (266,244 participants, offspring aged 19-55) were pooled. Adults exposed in utero to HDP had higher systolic (+3.40 mmHg) and diastolic blood pressure (+2.19 mmHg) and more hypertension (OR 1.50). Female offspring had 72% higher odds of developing HDP themselves (OR 1.72) and 90% higher odds of preeclampsia (OR 1.90). Exposure to HDP and severe preeclampsia was also associated with more premature acute coronary syndrome and higher stroke risk. HDP heritability is thus high, and exposure is associated with hypertension, acute coronary syndrome and stroke in offspring — arguing for lifestyle advice, monitoring and prevention.
Hypertension, Volume 83, Issue 6, Page e25834, June 1, 2026. The heritability of hypertensive disorders of pregnancy (HDP) and HDP’s association with cardiovascular disease in adult offspring were explored through a systematic review and meta-analysis. MEDLINE and EMBASE were searched independently by 2 reviewers (inception to February 18, 2025). Maternal chronic hypertension, antenatal complications, and pediatric cardiovascular disease were excluded. The Critical Appraisal Skills Program checklist was used for critical appraisal. Random-effects meta-analysis was conducted using a generic inverse variance method. Narrative synthesis and pooled results were expressed as odds ratios with 95% CIs. Of 225 studies screened, 11 studies (n=59 185; 48.3% women) assessed cardiovascular disease, and 9 studies (n=58 512) assessed HDP. Offspring age ranged from 19 to 55 years. There were 11 good- and 9 fair-quality studies. Fifteen studies were included in the meta-analysis (n=266 244). Adult offspring exposed to HDP had systolic and diastolic blood pressure that was 3.40 mm Hg (95% CI, 2.44–4.37; I2=40%) and 2.19 mm Hg higher (95% CI, 1.40–2.98; I2=51%). Higher odds of hypertension were observed (odds ratio, 1.50 [95% CI, 1.18–1.91]; I2=66%). Female offspring exhibited 72% increased odds of HDP (OR, 1.72 [95% CI, 1.41–2.09]; I2=81%) and 90% increased odds of preeclampsia (odds ratio, 1.90 [95% CI, 1.47–2.46]; I2=36%) following exposure to the same disorders. Increased odds of premature acute coronary syndrome and higher stroke risk were observed following HDP and severe preeclampsia exposure, respectively. In adult offspring, heritability of HDP was high. HDP were associated with hypertension, acute coronary syndrome, and stroke. Lifestyle modifications, cardiovascular disease monitoring, and prevention are paramount.
