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RATIONALE Knowledge gaps exist regarding health implications of sleep disordered breathing (SDB) identified in pregnancy and/or post-delivery. OBJECTIVE To determine whether SDB in pregnancy and/or post-delivery is associated with hypertension (HTN) and metabolic syndrome (MS). METHODS The nuMoM2b Heart Health Study (n=4,508) followed participants initially recruited during their first pregnancy. Participants returned for a visit 2-7 years after pregnancy. This study examined a subgroup who underwent SDB assessments during their first pregnancy (n=1,964) and a repeat SDB assessment post-delivery (n=1,222). Two SDB definitions were considered: apnea-hypopnea index (AHI) ≥5; oxygen desaturation index (ODI) ≥5. Associations between SDB and incident HTN and MS were evaluated with adjusted risk ratios (aRR). RESULTS The aRR for MS given an AHI ≥5 during pregnancy was 1.44 (95% CI 1.08, 1.93), but no association with HTN was found. ODI ≥5 in pregnancy was associated with both an increased risk for HTN (aRR 2.02, 95% CI 1.30, 3.14) and MS (aRR 1.53, 95% CI 1.19, 1.97). Participants with an AHI ≥5 in pregnancy that persisted post-delivery were at higher risk for both HTN (aRR 3.77, 95% CI 1.84, 7.73) and MS (aRR 2.46, 95% 1.59, 3.76). Similar associations were observed for persistent post-delivery ODI ≥5. CONCLUSIONS An AHI ≥5 in pregnancy was associated with an increased risk of MS. An ODI ≥5 in pregnancy was significantly associated with both HTN and MS. Participants with persistent elevations in AHI and ODI both during pregnancy and at 2-7 post-delivery were at the highest risk for HTN and MS.