Cardiovascular disease in pregnancy: physiology, global burden, risk stratification, and opportunities in care

Cardiovascular disease remains one of the leading causes of maternal mortality worldwide and a major driver of long-term morbidity. Yet, pregnancy-related cardiovascular complications are often under-recognised and variably managed across global settings. This three-part Series examines the continuum of cardiovascular risk surrounding pregnancy-from preconception through to lifelong surveillance. In the first paper in this Series, we describe the haemodynamic changes of pregnancy and global trends of congenital and acquired heart disease before pregnancy, evaluate established risk-stratification tools, and discuss the importance of multidisciplinary care. We focus on the existing burden of cardiovascular disease during pregnancy and related maternal and fetal complications. The second paper focuses on hypertensive disorders of pregnancy-the most common cardiovascular complication during pregnancy worldwide-detailing the pathophysiology, risk factors, and innovative care-delivery models to bridge gaps in longitudinal management. Finally, the third paper examines the association between adverse pregnancy outcomes and future cardiovascular disease, delineating mechanistic pathways, early interventions, and subsequent cardiovascular care. Together, this Series underscores pregnancy as a pivotal window into women's lifelong cardiovascular health and calls for integrated, equitable strategies to prevent avoidable maternal and fetal complications, while substantially lowering the lifetime risk of cardiovascular disease across diverse populations.