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Objectives Pregnancy in women with rheumatic diseases (RD) carries a higher risk of gestational hypertensive disorders (GHD) and subsequent chronic cardiovascular disease (CVD). Literature on the matter is scarce and because Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS) mainly affect women of reproductive age and are already linked to increased cardiovascular risk, it is important to understand how a history of GHD might further worsen these conditions. The aim of this study was to evaluate the incidence and type of CVD in RD patients who had experienced GHD.Methods We conducted a monocentric retrospective observational study, reviewing records of patients with RD who had pregnancies complicated by GHD followed between 1985 and 2025. Eligible patients had a confirmed diagnosis of RD, a history of GHD, and at least 5 years of postpartum follow-up. Cardiovascular events considered were major CV disorders, chronic hypertension, and ischemic foci on brain MRI.Results The cohort included 41 patients, with age at follow up ranging from 31 to 64 years (mean 45). APS was the most common diagnosis (18; 43.9%), followed by SLE (12; 29.3%). All had a history of GHD, most often preeclampsia (17; 41.5%) or HELLP syndrome (9; 22%). Over half of the cohort (21/41; 51.2%) developed at least one cardiovascular condition, most frequently chronic hypertension (19/41; 46.3%). Six patients (14.6%) experienced more than one CVD. In eight women, the event occurred within 5 years from the GHD, in five between 5 and 10 years, and in two after more than 10 years. In six cases, the time of onset of CVD was unknown. Among 12 patients affected by SLE, 6 patients showed newfound alterations indicative of hypertensive cardiomyopathy at echocardiography.Abstract PO:08:201 Table 1–2Conclusions Although multidisciplinary management has improved outcomes, pregnancies in women with RD still carry higher risks than in the general population. In our cohort, chronic hypertension after GHD was common and not negligible, affecting 46.3% of the total cohort and 50% of the patients affected by SLE. These results underline the importance of both early and long-term cardiovascular follow-up since continuous risk assessment and early intervention may help reduce further complications.