<p>Preeclampsia is a complex, hypertensive pregnancy disorder which is linked to an increased cardiovascular disease risk in both mothers and their offspring. Maternal haemodynamic adaptation during gestation is essential for adequate foetal nutrient supply and development, fundamentally shaping the offspring’s cardiovascular health trajectory. In preeclampsia, this process is disrupted, leading to lasting effects for both the mother and the child. While the clinical features of preeclampsia in this context have been subject to extensive investigation, it remains a critical challenge to elucidate the molecular mechanisms underpinning its long-term cardiovascular consequences. This review synthesises multi-omics, including genomics, epigenomics, transcriptomics and metabolomics, and systems-biology insights to elucidate mechanisms, identify candidate biomarkers, and shape personalised medicine approaches. By bridging molecular and clinical understanding, we discuss how these approaches uncover prenatal adversity from preeclampsia exposure influencing cardiovascular disease risk in mothers and offspring, offering a roadmap to improve long-term cardiovascular outcomes.</p><p></p>