Preconception Evaluation for Cardiovascular Disease: Who, What, and Why?

Preconception counseling and evaluation for individuals with cardiovascular disease is essential to optimize maternal and fetal outcomes by identifying risk and stabilizing conditions before pregnancy. It should be offered to patients with structural heart disease, cardiomyopathies, arrhythmias, valvular disease, aortopathies, prior adverse pregnancy outcomes, or significant cardiovascular risk factors. Key components include risk stratification, targeted diagnostic testing, medication review, and counseling on pregnancy timing, expected course, and contraception when appropriate. This approach can reduce severe maternal morbidity, improve fetal outcomes, and enhance care coordination. Preconception evaluation enables informed decision-making and focuses care on prevention, improving pregnancy and long-term cardiovascular health.