Pregnancy is a profound physiologic stress test that unmasks a woman's future cardiometabolic disease risk through gestational diabetes, preeclampsia, and other complications—yet remains critically underfunded in research. In this episode, Dr. Kathryn Gray, a maternal-fetal medicine specialist, explains how the body adapts to pregnancy, why 5-7% of women develop preeclampsia, what gestational diabetes reveals about long-term health, and why the U.S. lags behind other developed nations in maternal outcomes despite incredible advances. Pregnancy triggers a 50% plasma volume expansion and metabolic shift toward insulin resistance by the second trimester, a physiologic adaptation that reveals genetic predisposition to future type 2 diabetes and hypertension in women who develop gestational diabetes or preeclampsia.