Vascular Physiology and Pregnancy Complications

Maternal vascular adaptations to pregnancy optimize uterine and fetoplacental perfusion. When vascular remodeling and/or function are impaired, the maternal circulation may fail to meet the physiological demands of pregnancy, thereby increasing the risk of complications. The most common complications of pregnancy affecting maternal vascular health include hypertensive disorders of pregnancy, particularly preeclampsia; infectious or autoimmune diseases that often induce a preeclampsia-like phenotype; metabolic disorders such as gestational diabetes mellitus and excessive hypercholesterolemia; and advanced maternal age. Moreover, women with a history of a complicated pregnancy have an increased risk of developing later-life cardiovascular disease, representing a sex-specific risk factor. This review summarizes the mechanisms underlying vascular adaptations to pregnancy and examines how abnormal vascular changes within and beyond the uteroplacental circulation contribute to the development of pregnancy complications, as well as how these complications, in turn, affect maternal vascular health during pregnancy and later in life, focusing on underlying mechanisms.