**9. Conclusions**

Placental cellular function and development may be controlled by maternal systemic and local uterine cardiovascular perfusion, rather than vice versa. The key role of the placenta and its discarded products in causing maternal endothelial disfunction during pregnancy is doubtless; nevertheless, the predisposition of women with cardiovascular dysfunction for developing preeclampsia, the development of cardiovascular dysfunction prior to disease onset, the predominance of cardiovascular signs/biology at presentation, and the long-term cardiovascular health risks post-partum all support the assertion that preeclampsia could be a primary cardiovascular disorder. Significant advances in screening, diagnosis, management, and post-partum cardiovascular health after preeclampsia may occur as we acknowledge this paradigm shift in disease causality.

**Author Contributions:** Conceptualization, B.T.; Writing—Original Draft Preparation, A.R. and V.G.; Writing—Review & Editing, B.T. and A.K.

**Funding:** Anna Ridder and Veronica Giorgione's are part of the iPLACENTA project, which has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie gran<sup>t</sup> agreemen<sup>t</sup> No 765274.

**Conflicts of Interest:** The authors declare no conflict of interest. The funder had no role in the design of the study and in the writing of the manuscript.
