OBJECTIVES: To examine the prospective association between perception of health during pregnancy and cardiovascular risk factor of mothers 21 years after the index pregnancy.  METHODS: Data used were from the Mater University Study of Pregnancy (MUSP), a community- based prospective birth cohort study begun in Brisbane, Australia, in 1983. Logistic regression analyses were conducted. RESULTS: Data were available for 3692 women. Women who perceived themselves as not having a straight forward pregnancy had twice the odds (adjusted OR 2.0, 95% CI 1.1-3.8) of being diagnosed with heart disease 21 years after the index pregnancy as compared to women with a straight forward pregnancy. Apart from that, women who had complications (other than serious pregnancy complications) during the pregnancy were also at 30% increased odds (adjusted OR 1.3, 95% CI 1.0-1.6) of having hypertension 21 years later. CONCLUSIONS: As a whole, our study suggests that pregnant women who perceived that they had complications and did not have a straight forward pregnancy are likely to experience poorer cardiovascular outcomes 21 years after the pregnancy.