Advanced maternal age at first delivery: an early window into cardiovascular vulnerability

This invited editorial refers to ‘Advanced maternal age at first delivery as a risk factor for long-term cardiovascular disease’, by M. Yanoshvsky et al., https://doi.org/10.1093/ehjqcco/qcag076. The epidemiology of motherhood is changing—and with it, perhaps, our understanding of cardiovascular risk. Across many countries, women are increasingly delaying their first pregnancy. This demographic transition is easy to observe and well recognized within obstetrics. Yet, what remains less clear is whether delayed motherhood carries cardiovascular information that extends beyond reproductive health itself.1,2 In this issue, Yanoshvsky et al. revisit this question through a large population-based cohort and report an association between advanced maternal age (AMA) at first delivery and long-term cardiovascular morbidity.3 Their study, including more than 47 000 primiparous women followed for over a decade, provides evidence at a scale that is difficult to dismiss. The signal is remarkably consistent: as maternal age at first delivery increases, so does the risk of hypertension and vascular disease, even after adjustment for traditional cardiovascular risk factors and pregnancy-related complications (Figure 1).