Clinical Considerations in Management of Hypertrophic Cardiomyopathy in Pregnancy: JACC State-of-the-Art Review

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Genetics

Background:

• Hypertrophic cardiomyopathy (HCM) presents unique challenges during pregnancy, including hemodynamic instability and arrhythmias.
• While maternal mortality is generally low, careful management is crucial for optimizing outcomes.
• Existing evidence requires synthesis to guide clinical practice.

Purpose of the Study:

• To review and synthesize current evidence on managing hypertrophic cardiomyopathy in pregnancy.
• To provide guidance on preconception risk stratification, genetic counseling, and antepartum/postpartum care.
• To highlight the importance of multidisciplinary management for complex cases.

Main Methods:

• Systematic review and synthesis of current literature on HCM in pregnancy.
• Analysis of key clinical considerations: risk stratification, genetic counseling, surveillance, arrhythmia management, and delivery.
• Application of established risk classification systems (e.g., CARPREG II, modified WHO) for monitoring.

Main Results:

• Pregnancy is generally well-tolerated in low-risk women with HCM.
• Severe left ventricular outflow tract obstruction or systolic dysfunction indicates high maternal-fetal risk.
• Multidisciplinary heart team management is essential for optimizing care.

Conclusions:

• Effective management of HCM in pregnancy hinges on preconception counseling and risk stratification.
• Continuous monitoring and tailored interventions are vital for managing hemodynamic and arrhythmic risks.
• A multidisciplinary approach ensures comprehensive care throughout the reproductive continuum.