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Tara, a 24 year-old woman of Sri Lankan ancestry, was diagnosed with borderline chronic hypertension just 4 months before her first pregnancy. While she experienced a healthy childhood and normal pubertal development, by age 22 years her body mass index (BMI) was 29 kg/m2. The first pregnancy was complicated by chronic hypertension and superimposed preeclampsia (PET), necessitating Caesarian delivery at 33 weeks gestation. In her third pregnancy she was diagnosed with gestational diabetes mellitus (DM), and delivered a 4100 g macrosomic infant boy by Caesarian section. By age 42 years, Tara was started on oral medications for Type 2 DM and hypertriglyceridaemia; 9 years later she suffered a small lacunar stroke, leaving her with moderate left-sided weakness of the arm and leg. Her own mother had experienced “high blood sugars” during pregnancy, was overweight, and died at age 54 years from the complications of high blood pressure.
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