Sage Wyatt, PhD, discusses cardiovascular risk assessment through HDP

In a discussion with Contemporary OB/GYN, Sage Wyatt, PhD, postdoctoral researcher at Utrecht University, outlined emerging insights into hypertensive disorders of pregnancy (HDP) and the long-term cardiovascular implications for affected mothers.^1,2

Traditionally, clinical and research frameworks have emphasized the well-established triad of HDP, preterm birth, and small-for-gestational-age (SGA) infants. This pattern has long been attributed to placental dysfunction, in which vascular resistance and impaired placental perfusion limit fetal growth, prevent full-term gestation, and contribute to maternal hypertension.

These SGA infants often require specialized neonatal care, such as neonatal intensive care unit support, and have been the focus of extensive obstetric and perinatal research. Wyatt’s work shifts attention from pregnancy and neonatal outcomes to maternal health in the years after delivery.

Her research examines how combinations of pregnancy characteristics can form risk profiles that predict a woman’s likelihood of developing future cardiovascular disease, including myocardial infarction and stroke. While the association between HDP, preterm birth, and SGA infants is well documented, Wyatt emphasized that researchers have largely overlooked a critical subgroup: mothers with HDP who deliver preterm but have infants who are large for gestational age (LGA).

According to Wyatt, this newly recognized phenotype challenges longstanding assumptions about placental pathology and fetal growth patterns in HDP. The presence of LGA infants in hypertensive pregnancies suggests the possibility of distinct biological mechanisms, multiple etiologies, or divergent placental processes that ultimately produce similar maternal symptoms. As an analogy, she compares this evolving understanding to the differentiation between type 1 and type 2 diabetes—conditions with overlapping manifestations but fundamentally different origins and therapeutic considerations.

Wyatt argues that identifying this HDP–preterm–LGA subtype opens an important avenue for future investigation. Researchers will need to determine why some hypertensive pregnancies result in growth-restricted infants, while others produce larger-than-expected infants, and whether these differences correspond to varying risks for long-term cardiovascular disease. She underscored the value of questioning entrenched clinical assumptions and encouraged the field to “think outside of the box,” particularly as decades of emphasis on SGA outcomes may have obscured alternative patterns with meaningful implications for maternal health.

Overall, this evolving line of inquiry has the potential to refine cardiovascular risk stratification for postpartum patients and broaden the understanding of HDP pathophysiology.

No relevant disclosures.

References

1. Women with large preterm infants have higher risk of cardiovascular disease later in life. The University of Bergen. October 20, 2025. Accessed October 22, 2025. https://www.eurekalert.org/news-releases/1102602.
2. Wyatt S, Skjærven R, Vatten L, et al. Hypertensive disorders of pregnancy, preterm delivery, and infant size: Which mothers have highest cardiovascular disease mortality? Pediatric and Perinatal Epidemiology. 2025. doi:10.1111/ppe.70033