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Cardiovascular Disease in Pregnancy: When Two Hearts Beat as One

Chiara Tognola1, Filippo Brucato2, Alessandro Maloberti1,2

  • 1Clinical Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy.

Diagnostics (Basel, Switzerland)
|November 27, 2025
PubMed

Insights

Cardiovascular disease in pregnancy poses significant risks. This review synthesizes evidence on managing cardiomyopathies, anticoagulation, and hypertension, emphasizing multidisciplinary care for improved maternal outcomes.

Area of Science:

  • Cardiology and Obstetrics
  • Maternal-Fetal Medicine
  • Cardiovascular Health in Pregnancy

Background:

  • Cardiovascular disease (CVD) is a leading cause of maternal morbidity and mortality globally.
  • Physiological changes during pregnancy can exacerbate existing CVD or reveal subclinical conditions.
  • Pregnancy acts as a natural cardiovascular stress test.

Purpose of the Study:

  • To critically review current evidence and guidelines for managing pregnancy-related cardiovascular disorders.
  • To focus on pathophysiological mechanisms, diagnostic challenges, and therapeutic controversies.
  • To analyze contemporary management strategies for high-impact clinical domains.

Main Methods:

  • Comprehensive review of contemporary evidence and international guidelines.
  • Focused discussion on peripartum/preexisting cardiomyopathies, anticoagulation in mechanical prosthetic valves, and hypertensive disorders of pregnancy.
  • Comparative analysis of European Society of Cardiology (ESC) 2025 and American Heart Association (AHA) 2020 recommendations.

Main Results:

  • Shared pathophysiological mechanisms include endothelial dysfunction, angiogenic imbalance, and systemic inflammation.
  • Broad consensus exists between ESC and AHA guidelines, with some discrepancies in anticoagulation targets and postpartum surveillance.
  • Recent trials (CHAP, WILL) offer new insights into hypertensive disorders and long-term prevention.

Conclusions:

  • Multidisciplinary care via Pregnancy Heart Teams is crucial for integrating obstetric and cardiologic expertise.
  • Structured postpartum follow-up pathways are essential for improving outcomes in women with pregnancy-related cardiovascular conditions.
  • Addressing shared mechanisms and guideline discrepancies can enhance maternal cardiovascular health.

Keywords:
anticoagulationcardiovascular diseaseendothelial dysfunctionhypertensive disordersperipartum cardiomyopathypostpartum follow-uppregnancypregnancy heart teamvalvular disease

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