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This study aimed to assess the potential relationship between pre-pregnancy HTN, HDP, and diabetes and their cumulative impact on maternal cardiovascular outcomes defined as incident CHD and all-cause mortality within 5 years of delivery and over the entire study period (up to 14 years after delivery).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This retrospective cohort study included 430,545 women aged 12\u201349 with \u2265\u20091 singleton, live birth in South Carolina (2004\u20132016) including non-Hispanic White (NHW; 59.2%), non-Hispanic Black (NHB; 31.4%), and Hispanic (9.4%) women. Birth certificate and hospitalization\/emergency department (ED) visit data defined pre-pregnancy HTN, HDP (preeclampsia, eclampsia, gestational HTN), and diabetes (pre-pregnancy, gestational). Hospitalization\/ED visit and death certificate data defined incident CHD and all-cause mortality. Covariate-adjusted Cox proportional hazard models were used to assess associations between CHD and mortality by exposure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>After adjustment for covariates relative to women without any of the three conditions (diabetes, pre-pregnancy HTN, HDP), incident CHD risk was increased within 5 years of delivery for women with diabetes (HR\u2009=\u20091.57; 95% CI 1.28\u20131.92), HDP (HR\u2009=\u20091.85; 95% CI 1.60\u20132.15), HDP and diabetes (HR\u2009=\u20092.29; 95% CI 1.73\u20133.03), HDP and pre-pregnancy HTN (HR\u2009=\u20093.13; 95% CI 2.66\u20133.68), and all three conditions (HR\u2009=\u20094.87; 95% CI 3.95\u20136.01). All-cause mortality risk was increased for diabetes (HR\u2009=\u20091.34; 95% CI 1.01\u20131.78), HDP and pre-pregnancy HTN (HR\u2009=\u20091.53; 95% CI 1.15\u20132.03), and all three conditions (HR\u2009=\u20092.25; 95% CI 1.51\u20133.36), but not HDP or HDP and diabetes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Within 5 years of delivery, incident CHD and all-cause mortality rates were highest for women with two or three conditions, specifically HDP, diabetes, and\/or pre-pregnancy HTN, with all rates higher for NHB than NHW women. Thus, it is critical to implement clinical prevention strategies to improve risk factor screening and identification among women of child-bearing age.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12933-025-02811-8","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T07:21:05Z","timestamp":1752218465000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Maternal coronary heart disease and mortality following hypertensive disorders of pregnancy and\/or diabetes"],"prefix":"10.1186","volume":"24","author":[{"given":"Angela M.","family":"Malek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dulaney A.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Mateus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A.","family":"Ash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya N.","family":"Turan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Lackland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly J.","family":"Hunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"2811_CR1","first-page":"1","volume":"427","author":"SL Murphy","year":"2021","unstructured":"Murphy SL, Kochanek KD, Xu J, Arias E. 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Permission was received from the dataset owner to use the information in the databases for the purposes of this research. Patient consent was waived due to the use of previously existing data provided in a limited dataset, and as individuals will not be contacted or identified.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"282"}}