Optimisation of maternal cardiometabolic outcomes after hypertensive disorders of pregnancy

Women with pregnancies complicated by hypertensive disorders of pregnancy (HDP) are at significantly increased risk of cardiovascular (CVD) and metabolic diseases. Current international guidelines acknowledge this risk, however the timing, duration and method of CV screening in these high-risk women remain heterogenous. There remains a lack of an evidenced-based approach to the transition of care from hospital to community and longer-term cardiac-metabolic disease prevention.This narrative review examines the optimal timing and duration of cardiometabolic surveillance after delivery, approaches to risk stratification to identify women at greatest risk of future cardiovascular morbidity, and strategies for screening myocardial, vascular, and metabolic health. This review also explores how limited postpartum healthcare resources may be targeted most effectively, with particular emphasis on the transition from hospital to community care during the "fourth trimester" and interventions that promote sustained engagement in long-term behavioural and lifestyle modification.Current evidence supports the potential role of multidisciplinary postpartum cardiovascular clinics in delivering coordinated, risk-stratified care following HDP. These clinics facilitate early optimisation of BP through telemonitoring and patient-led medication titration, while integrating lifestyle interventions tailored to PE phenotypes and individual CV risk profiles. Future research should focus on validated risk stratification tools to identify and personalise postpartum interventions to women who are most at risk of CV morbidities. This should include risk prediction, targeted interventions based on risk profiles, and integrated care pathways in the community to optimise long-term maternal CV outcomes.