Maternal Vascular Adaptation and Function in Cardiometabolic Complications of Pregnancy

Pregnancy represents a unique physiological stress test for the cardiovascular system, requiring profound and finely regulated adaptations in vascular structure, endothelial function, and systemic hemodynamics. While most pregnancies achieve this transition successfully, cardiometabolic complications such as preeclampsia (PE), hypertensive disorders of pregnancy (HDP), and gestational diabetes mellitus (GDM) reveal distinct failure modes of maternal vascular adaptation, with consequences extending well beyond delivery and into long-term cardiovascular risk. This Research Topic aims to integrate mechanistic, clinical, and translational perspectives on how vascular and hemodynamic regulation is altered across these conditions, and how such alterations shape both maternal and fetal outcomes.A central focus will be on dynamic vascular function rather than static measurements. Contributions are encouraged that explore arterial stiffness, wave reflection, microvascular perfusion, and endothelial responsiveness across gestation and postpartum, using both conventional and emerging techniques. Particular interest lies in studies addressing microvascular integrity and the endothelial glycocalyx as early and potentially reversible targets of injury, linking circulating biomarkers, extracellular vesicles, and functional imaging to vascular health trajectories.The collection will also highlight interactions between metabolic dysregulation and vascular control. Insulin resistance, dyslipidemia, inflammation, and oxidative stress do not merely coexist with hypertensive phenotypes but actively reshape vascular tone, compliance, and reactivity. We welcome studies dissecting these bidirectional pathways, including omics-based approaches and integrative physiological modeling that connect molecular signals to systemic hemodynamic behavior.Another key area is maternal–placental–fetal coupling. Altered uteroplacental perfusion, placental signaling, and fetal vascular programming are increasingly recognized as contributors to both immediate obstetric complications and later cardiometabolic vulnerability in offspring. Submissions may address placental vascular biology, fetoplacental hemodynamics, and longitudinal follow-up of children exposed to adverse in-utero vascular environments, bridging obstetrics with life-course cardiovascular science.Finally, the Research Topic aims to stimulate work on risk stratification and therapeutic modulation. This includes studies evaluating whether vascular phenotyping can improve prediction beyond conventional clinical scores, and whether targeted interventions—pharmacological or lifestyle—can restore adaptive vascular responses when applied early in pregnancy or postpartum.By bringing together diverse methodological approaches and disciplinary viewpoints, this collection seeks to move the field beyond descriptive associations toward an integrated understanding of vascular maladaptation in cardiometabolic pregnancy complications, with the ultimate goal of improving both short-term obstetric care and long-term cardiovascular health for women and their children.Topic Editor Dr. Federica Piani declares the following conflict of interest: she has received honoraria from Berlin-Chemie, with no ongoing financial relationship. Prof. Maurizio Mandalà declares no conflicts of interest with regard to the Research Topic. Topic editors: Federica Piani, Maurizio Mandalà Source: https://www.frontiersin.org/research-topics/77673/maternal-vascular-adaptation-and-function-in-cardiometabolic-complications-of-pregnancy