Retnakaran R, et al. - An elevated lifetime risk of cardiovascular disease has been observed among women with either preterm or small‐for‐gestational‐age (SGA) delivery which has been attributed to the accrual of vascular risk factors over time. Researchers herein examined if these women have development of an adverse cardiovascular risk factor profile in the years prior to pregnancies complicated by preterm delivery or SGA. Using administrative databases, all 156,278 nulliparous women in Ontario, Canada, were identified who had singleton pregnancies between January 2011 and December 2018, and had ≥ 2 measurements of the following analytes between January 2008 and the start of pregnancy: glycosylated hemoglobin, glucose, lipids, and alanine aminotransferase. Among these women, preterm delivery occurred in 11,078 women and SGA was reported in 19,367. Pregravid glycosylated hemoglobin, glucose, low‐density lipoprotein cholesterol, triglycerides, and alanine aminotransferase were noted to be higher, and high‐density lipoprotein cholesterol was lower among women with preterm delivery relative to those without preterm delivery. In contrast, lower pregravid fasting glucose, random glucose, and triglycerides were reported in women with SGA vs those without SGA. In the years prior to pregnancy, higher annual increases were observed among women with preterm delivery vs their peers in glycosylated hemoglobin (0.7‐times higher), triglycerides (7.9‐times higher), and alanine aminotransferase (2.2‐times higher). During this time, women who developed preterm delivery show an increase in fasting glucose but their peers show a decrease. These findings suggest the evolution of an adverse cardiovascular risk factor profile over time in the years prior to pregnancy complicated by preterm delivery, but this does not necessarily precede SGA.