Preterm birth (PTB) is defined as delivery before 37 completed weeks of gestation (Centers for Disease Control and Prevention [CDC], 2023; World Health Organization [WHO], 2023). Multiple biological and social factors contribute to PTB risk. Maternal obesity, exposure to psychosocial stressors such as adverse childhood experiences (ACEs) and post-traumatic stress disorder (PTSD), and chronic inflammation have all been associated with increased risk of preterm delivery (Liu et al., 2020; Blackmore et al., 2016; March of Dimes, 2022). A history of preterm birth is one of the strongest predictors of recurrence in subsequent pregnancies (ACOG, 2021). In the United States, preterm birth imposes a substantial economic burden, with annual societal costs estimated to exceed $26 billion, reflecting medical care, early intervention services, and long-term developmental support (Institute of Medicine, 2007; CDC, 2023). Preterm birth also disproportionately affects women of color and women insured through Medicaid, reflecting persistent disparities in maternal health and access to care in the United States (Martin et al., 2023; March of Dimes, 2023).

Gestational diabetes mellitus (GDM) is typically diagnosed using a two-step screening approach in the United States. An abnormal 50-g oral glucose challenge test (≥140 mg/dL) is followed by a diagnostic 100-g, 3-hour oral glucose tolerance test (OGTT), with GDM diagnosed when two or more glucose values exceed established thresholds, including the fasting value (ACOG, 2018; ADA, 2024). Maternal obesity and gestational diabetes both increase the likelihood of delivering a large-for-gestational-age (LGA) infant due to increased fetal exposure to glucose and insulin-mediated growth (HAPO Study Cooperative Research Group, 2008; Catalano & Shankar, 2017). Women diagnosed with GDM also face a substantially elevated long-term risk of developing type 2 diabetes mellitus, with approximately 35–60% progressing to diabetes within 10–20 years after pregnancy (Bellamy et al., 2009; CDC, 2022).

Pregnancy-induced hypertension (PIH), more commonly referred to as gestational hypertension, occurs when a previously normotensive woman develops new-onset hypertension after 20 weeks of pregnancy. It is defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg on two occasions at least four hours apart (American College of Obstetricians and Gynecologists [ACOG], 2020; American Heart Association, 2021). When hypertension occurs in combination with proteinuria or other signs of maternal organ dysfunction, the condition is classified as preeclampsia (ACOG, 2020).

Hypertensive disorders of pregnancy increase the likelihood of delivering small-for-gestational-age (SGA) infants due to placental vascular dysfunction and impaired fetal growth (Roberts & Hubel, 2009; Burton et al., 2019).

Women who experience hypertensive disorders during pregnancy also have an elevated long-term risk of developing chronic hypertension. Studies report that chronic hypertension develops within two to five years after pregnancy in approximately 50% of women with early-onset preeclampsia, 39% following gestational hypertension, and 25% following late-onset preeclampsia (Benschop et al., 2019; Brown et al., 2018).

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American Diabetes Association. (2024). Management of diabetes in pregnancy: Standards of care in diabetes—2024. Diabetes Care, 47(Suppl. 1), S282–S294.

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Bellamy, L., Casas, J. P., Hingorani, A. D., & Williams, D. (2009). Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis. The Lancet, 373(9677), 1773–1779.

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Blackmore, E. R., et al. (2016). Previous prenatal loss as a predictor of perinatal depression and PTSD. Journal of Women's Health, 25(7), 712–718.

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Burton, G. J., Redman, C. W., Roberts, J. M., & Moffett, A. (2019). Pre-eclampsia: Pathophysiology and clinical implications. Physiological Reviews, 99(1), 541–597.

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Centers for Disease Control and Prevention. (2023). Preterm birth. U.S. Department of Health and Human Services.

Centers for Disease Control and Prevention. (2022). Gestational diabetes and risk of type 2 diabetes. U.S. Department of Health and Human Services.

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Martin, J. A., Hamilton, B. E., & Osterman, M. J. K. (2023). Births: Final data for 2022. National Vital Statistics Reports, 72(1).

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