Heart disease is the leading cause of death globally for both sexes, affecting 1 in 5 women in the United States. Although women have a lower prevalence of obstructive epicardial coronary artery disease compared with men of a similar age, they have higher rates of myocardial ischemia and associated cardiovascular morbidity and mortality. While both sex-based differences due to biological factors such as the timing of menarche and menopause and gender-related differences related to social constructs (eg, delays in time to evaluation of chest pain for women vs men) contribute to these disparities, there is a growing recognition that traditional cardiovascular risk calculators fail to account for sex-specific risk factors such as adverse pregnancy outcomes, which are unique to birthing people who predominantly identify as women. Adverse pregnancy outcomes, including pregnancy-induced hypertensive disorders (preeclampsia and gestational hypertension), preterm birth, and fetal growth restriction, are common manifestations of ischemic placental disease and share a vascular pathophysiologic origin. Along with gestational diabetes, adverse pregnancy outcomes comprise a group of sex-specific cardiovascular risk enhancers associated with a 2- to 4-fold increased risk of future heart disease. Unfortunately, due to a lack of detailed pregnancy history in most existing cohorts and clinical trials of coronary artery disease, to date it has been difficult to examine whether there is a difference in the pathophysiologic development of coronary artery disease in women with a history of adverse pregnancy outcomes compared with those with uncomplicated pregnancies.