Understanding how trajectories of maternal health both pre and during pregnancy relate to postnatal outcomes and future health outcomes (360G-Wellcome-338937_Z_25_Z)

This study will investigate how maternal cardiometabolic health before, during, and after pregnancy shapes long-term cardiovascular disease (CVD) risk. Pregnancy acts as a natural “stress test” of metabolic and vascular resilience, with complications such as gestational diabetes and preeclampsia revealing underlying susceptibility to later CVD. However, gaps remain in understanding the timing of when cardiometabolic risk peaks, adherence to guideline-recommended postnatal checks, and whether incorporating pregnancy history improves risk prediction. Using linked UK electronic health records (CPRD), birth cohorts (ALSPAC, Born in Bradford), Ugandan data, and genetic data, we will address four aims: (1) describe adherence to NICE postnatal care guidelines and identify underserved groups; (2) model trajectories of BMI, blood pressure, glucose, and lipids from pre-pregnancy up to two years postpartum, to identify optimal screening timepoints; (3) explore whether adding pregnancy information improves CVD risk prediction beyond standard models such as QRISK3; and (4) apply Mendelian Randomization (MR) to test causal relationships between adverse pregnancy outcomes and long-term cardiometabolic health. By integrating diverse datasets and advanced analytic approaches, this research will help inform policy on postnatal care, improve CVD risk prediction, and support more equitable prevention strategies for high-risk women. Keywords: cardiometabolic health, adverse pregnancy outcomes, electronic health records