Empowering Women's Choices in Pregnancy and CVD

In an empowering move for women with cardiovascular disease (CVD), the European Society of Cardiology (ESC) has released updated guidelines emphasizing the importance of personalized pregnancy risk assessments. The new recommendations highlight shared decision-making between physicians and patients, ensuring informed reproductive health choices.

Endorsed by the European Society of Gynecology (ESG), these guidelines not only replace the 2018 version but also incorporate fresh evidence and clearer organization, making them user-friendly. A focal point is the autonomy of women in high-risk pregnancies, reinforced by the necessity for comprehensive care teams.

The Benefits of a Multidisciplinary Pregnancy Heart Team

Dr. Julie De Backer from Ghent University Hospital highlighted at the ESC Congress 2025 that women monitored by specialized pregnancy heart teams experience significantly better outcomes. However, care accessibility varies by region, underscoring the urgency of addressing geographical disparities in maternal health care.

A top-notch pregnancy heart team typically includes a cardiologist, anesthesiologist, midwife obstetrician, and clinical nurse specialist. Depending on individual needs, other specialists such as geneticists, primary care physicians, and psychologists may also join the team.

Updated Guidance on Rare Conditions

The guidelines deviate from traditional advice discouraging pregnancy in specific conditions like Ehlers-Danlos syndrome. Instead, they advocate for personalized counseling that factors in a woman’s genetic background and medical history.

Enhanced Risk Assessment and Classification

A key update in the guidelines is the refined maternal cardiovascular risk classification. The new recommendations incorporate data from the CARPREG II study, allowing for a detailed risk index that aids clinicians in identifying patients who should be referred to pregnancy heart teams.

Detailed sections cover various cardiovascular issues that can arise during and after pregnancy, such as peripartum cardiomyopathy, congenital heart disease, and pregnancy-induced hypertension.

Safe Delivery Practices and Long-Term Monitoring

As for delivery methods, the guidelines advocate for vaginal birth for most women with CVD, while noting exceptions like acute heart failure or other high-risk situations, where cesarean sections may be warranted.

Furthermore, the guidelines stress the importance of monitoring women with adverse pregnancy outcomes, recommending cardiovascular evaluations at 3 months postpartum and subsequent assessments as needed.

User-Friendly Tools for Clinicians

Dr. Kristina Hermann Haugaa, co-chair of the guidelines update, introduced helpful flowcharts that guide healthcare professionals in managing complex patient scenarios, including pregnancy-related heart failure. These tools are essential for ensuring safe and effective treatment.

A color-coded guide for medications during pregnancy and postpartum has been included as well, categorizing them as safe, second-choice, or contraindicated, making it easier for clinicians to make informed decisions.

A New Era for Maternal Cardiac Care

Overall, the revised ESC guidelines reflect a transformative approach to maternal health for women with cardiovascular conditions, ensuring they receive the understanding and care needed to navigate their pregnancies safely.