[ESC Guidelines on cardiovascular diseases and pregnancy-most important facts of the 2025 update]

The 2025 European Society of Cardiology (ESC) Guidelines on cardiovascular disease in pregnancy represents the second revision of the guideline versions published in 2011 and 2018. The new version aims to incorporate the most up-to-date evidence and update the resulting recommendations for clinical practice. The experts appointed by the ESC constitute a new task force compared with the first two versions. However, the thematic focus does not differ fundamentally from the 2018 guidelines. In view of the expanding evidence base, several chapters have become substantially more precise, for example those on risk stratification in women with pre-existing cardiovascular disease; the need for structured, obligatory postpartum follow-up in the event of complications during pregnancy; and the recommended measures for pre-pregnancy screening and counselling. The recommendations continue to be based predominantly on level C evidence, i.e., on expert opinion and consensus. Since the thalidomide scandal in 1962, there have been very few prospective randomized trials including pregnant women. Explicit presentation of level C evidence is therefore particularly important, as individual physicians are only rarely involved in the care of pregnant women. This task is demanding, because both the pregnant woman and the fetus require individual consideration. This should, however, not be discouraging but rather viewed as a positive challenge. This work is substantially supported by the establishment of the institution of a "Pregnancy Heart Team." These teams, usually available 24/7 in larger centers, ensure interdisciplinary collaboration among multiple specialties and professions in order to arrive at the best possible decisions for both mother and child. The 2025 guidelines devote an expanded chapter to this topic.