Cardiovascular Disease in Pregnancy: When Two Hearts Beat as One.

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.