Generation XXI is a birth cohort sized 8500 that was assembled in 2005-2006 in Porto.

The main focus of birth cohorts has been on children, their current and future health. In a sample of 3000 mothers of this Portuguese birth cohort we aim:

1) to estimate the prevalence of cardiovascular risk factors (smoking, hypertension, dyslipidemia, diabetes mellitus, obesity/overweight), before the current pregnancy;

2) to assess, using the approach of a cohort study, the association between age at birth, prepregnancy body mass index and parity and weight gain during pregnancy, percent recovery of prepregnancy BMI, blood pressure, serum lipids, fasting blood glucose and high-sensitivity C-reactive protein serum level 3 years after delivery;

3) to assess, using the approach of a case-control study, the association between cardiovascular outcomes of pregnancy (gestational hypertension and diabetes, mild gestational hyperglycemia, eclampsia/pre-eclampsia, intrauterine growth restriction, low birth weight and macrosomic newborn) and age, prepregnancy BMI, parity;

4) to assess the association between cardiovascular outcomes of pregnancy and childhood overweight/obesity at 3 years;

5) to assess the interaction between cardiovascular risk factors and genetic polymorphisms in the IL-6 gene.

We defend, in line with other investigators in clinical epidemiology of cardiovascular diseases, that large prospective longitudinal studies should be undertaken to examine changes in conventional risk factor pathways (lipids, blood pressure, haemostatic factors) and novel pathways (inflammation, insulin resistance) during and after pregnancy.

Moreover, a life-course perspective on health and its social determinants, such as familiar antecedents, childhood, social context and psychological characteristics of the mother, are expected to provide interesting insights to the understanding and prevention of cardiovascular diseases.