IMPORTANCE: Adverse pregnancy outcomes, including hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), influence maternal cardiovascular heath (CVH) long after pregnancy, but their relationship to CVH in the offspring remains uncertain. OBJECTIVE: To examine associations of HDP and GDM with offspring CVH in early adolescence. DESIGN, SETTING, PARTICIPANTS: This cohort study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study from 2000 to 2006 and the HAPO Follow-Up Study from 2013 to 2016. This analysis included 3,317 mother-child dyads from 10 field centers, comprising 70.8% of HAPO Follow-Up Study participants. Those with pregestational diabetes and chronic hypertension were excluded. EXPOSURES: The exposures were any GDM and HDP compared with none (reference), respectively. MAIN OUTCOMES AND MEASURES: Offspring CVH at ages 10 to 14 years, based on four metrics: body mass index, blood pressure, total cholesterol level, and glucose level. Each metric was categorized as ideal, intermediate, or poor using a framework provided by the American Heart Association. The primary outcome was having at least one metric that was non-ideal versus all ideal (reference). RESULTS: Among 3,317 maternal-child dyads, the median (IQR) ages were 30.4 (25.6, 33.9) years for pregnant individuals and 11.6 (10.9, 12.3) years for children. During pregnancy, 10.4% of individuals developed HDP, and 14.6% developed GDM. At follow-up, 55.5% of offspring had at least one less-than-ideal CVH metric. In adjusted models, HDP (aRR 1.14; 95% CI 1.04, 1.25) and GDM (aRR 1.10; 95% CI 1.02, 1.19) were associated with greater risk that offspring developed less-than-ideal CVH. CONCLUSONS AND RELEVANCE: In this multi-national prospective cohort, HDP and GDM were each significantly associated with worse offspring CVH at ages 10 to 14 years.