Pregnancy biomarkers as early indicators of cardiovascular risk: a discussion article

Pregnancy provides a unique opportunity for early cardiovascular prevention by revealing maternal vascular and cardiometabolic vulnerability. Placental growth factor (PlGF), uterine artery Doppler and emerging inflammatory biomarkers may improve the identification of placental dysfunction and adverse pregnancy outcomes. However, their ability to predict long-term maternal cardiovascular risk remains uncertain. PlGF performance varies according to gestational age, clinical setting, population and assay platform, while inflammatory biomarkers such as S100A8/A9 remain investigational. Importantly, detecting placental dysfunction, recognising an adverse pregnancy outcome as a cardiovascular risk marker and demonstrating incremental long-term prognostic value are distinct concepts. Current evidence does not support biomarker-guided postpartum cardiovascular management. Obstetric history should therefore remain the principal trigger for cardiovascular counselling and follow-up. Prospective studies should determine whether standardised angiogenic and inflammatory biomarkers improve prediction beyond clinical and obstetric characteristics and whether their use translates into better cardiovascular outcomes.