Cardiac Biomarkers and Pregnancy-Associated Cardiovascular Disease

Pregnancy represents a stress test that provides insights into maternal cardiovascular health across the life course. Cardiovascular biomarkers are widely used outside of pregnancy for diagnosis and monitoring of cardiovascular disease, yet their interpretation and clinical utility during pregnancy remain poorly understood. This review summarizes current evidence on cardiovascular biomarkers in pregnancy, including traditional cardiac biomarkers, emerging biomarkers, and digital biomarkers, and areas requiring further investigation.

During pregnancy, natriuretic peptides and cardiac troponin levels retain their negative predictive value, with levels remaining below diagnostic thresholds for cardiovascular disease diagnosis. Novel biomarkers for hypertensive disorders of pregnancy and other pregnancy-associated cardiovascular conditions, including angiogenic markers such as sFlt-1 and placental growth factor, inflammatory markers, adipokines, and high-throughput proteomic and metabolomic markers, are also increasingly being evaluated. Additionally, advances in digital health technologies have introduced digital biomarkers derived from wearable devices and remote monitoring platforms, which may allow continuous monitoring for early detection of cardiovascular complications during pregnancy. Cardiovascular biomarkers represent important tools for the diagnosis and management of cardiovascular disease during pregnancy. While traditional biomarkers remain clinically useful, emerging biological and digital biomarkers offer promising opportunities for earlier detection, improved risk stratification, and enhanced monitoring of pregnancy-related cardiovascular disease. Larger, diverse studies with longitudinal follow-up are needed to establish pregnancy-specific reference ranges, validate emerging biomarkers, and determine how pregnancy biomarker profiles can inform long-term cardiovascular risk prediction for women.