Abstract Introduction Preeclampsia and fetal growth restriction, which are clinical presentations of placental dysfunction, are frequently associated with angiogenic imbalance during pregnancy and increased long‐term cardiovascular risk. Whether this risk is driven by the pre‐pregnancy risk factors, clinical disease, or by an elevated sFlt‐1/PlGF ratio remains unclear. This study aimed to assess the association between vascular assessments (ophthalmic artery Doppler and carotid intima‐media thickness) 3–6 years postpartum and a history of preeclampsia and fetal growth restriction, and to evaluate if associations were impacted by an angiogenic imbalance during pregnancy. Material and Methods This was a cross‐sectional study, which included individuals prospectively recruited during their index pregnancy between 2018 and 2021 and re‐evaluated 3–6 years postpartum. Preeclampsia, fetal growth restriction, and sFlt‐1/PlGF values were defined from pregnancy data. Postpartum assessment included ophthalmic artery Doppler and carotid intima‐media thickness performed by a single operator. Multivariable linear regression models assessed associations between placental dysfunction, angiogenic imbalance, and vascular parameters, adjusting for maternal covariates. Results 354 participants were included, 148 with and 206 without a history of preeclampsia or fetal growth restriction. Both placental dysfunction and angiogenic imbalance during pregnancy were independently associated with a significantly higher ophthalmic artery peak systolic velocity ratio 3–6 years postpartum. Participants with a history of placental dysfunction showed higher values compared to those without 0.75 (0.67–0.81) vs. 0.69 (0.63–0.78), p = 0.03, as did those with an elevated sFlt‐1/PlGF ratio during pregnancy 0.76 (0.66–0.82) vs. 0.70 (0.64–0.78), p = 0.03. The highest values were observed in women who had experienced both conditions. When preeclampsia and fetal growth restriction were analyzed separately, the association remained significant for preeclampsia, whereas in the fetal growth restriction group, a significant difference was observed only in the right eye. No statistically significant differences were observed in carotid intima‐media thickness. Conclusions Both a history of angiogenic imbalance and a clinical placental dysfunction presentation (particularly preeclampsia) during pregnancy were associated with increased ophthalmic artery peak systolic velocity ratio 3–6 years postpartum, whereas carotid intima‐media thickness did not differ between the study groups.
García‐Manau et al. (Tue,) studied this question.