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Background: Early cardiovascular disease risk detection opportunities are limited in men, whereas gestational diabetes, gestational hypertension and preeclampsia are risk indicators in women. We hypothesised adverse pregnancy outcomes also signal risk in fathers, due to shared environments and behaviours.

Methods: Our retrospective cohort study included fathers whose female partners had at least two singleton deliveries between April 1990 and December 2012. We examined population-based data up to April 2019 from Quebec province, Canada (health administrative databases, birth, stillbirth and death registries). The primary exposure was cumulative gestational diabetes, gestational hypertension and preeclampsia occurrences across two pregnancies. Outcomes were new diagnoses of diabetes, hypertension and cardiovascular disease in fathers, analysed using Cox proportional hazards models.

Results: Among 415 730 fathers, 17 065 developed diabetes, 44 315 developed hypertension and 9695 experienced a cardiovascular disease event over more than a decade. Compared with no gestational diabetes or gestational hypertension/preeclampsia occurrences in partners, the hazards of diabetes in fathers increased by 21% with a single occurrence (HR 1.21, 95% CI 1.16 to 1.26), 40% with two (HR 1.40, 95% CI 1.30 to 1.50) and 84% with three or more (HR 1.84, 95% CI 1.54 to 2.21). Corresponding increases in hypertension hazards were 11% (HR 1.11, 95% CI 1.08 to 1.14), 17% (HR 1.17, 95% CI 1.12 to 1.23) and 39% (HR 1.39, 95% CI 1.22 to 1.58), respectively. Cardiovascular disease hazards increased by 15% with two or more occurrences (HR 1.15, 95% CI 1.04 to 1.27).

Conclusion: More maternal adverse pregnancy outcomes lead to greater paternal cardiometabolic disease hazards. Partner pregnancy history may help identify at-risk men to support early prevention.