2025 ESC Guidelines for the management of cardiovascular disease and pregnancy
31 Aug 2025
2025 ESC Guidelines for the management of cardiovascular disease and pregnancy Today, Professor Julie De Backer (Ghent University Hospital - Ghent, Belgium) and Professor Kristina H. Haugaa (Oslo University Hospital - Oslo, Norway) presented new guidelines on cardiovascular disease (CVD) and pregnancy,1 with a shift in clinical focus on various aspects and major updates based on evidence that has emerged since 2018.
One of the largest structural revisions is a dedicated section on the Pregnancy Heart Team. Prof. De Backer explains: “While the concept of the Pregnancy Heart Team was previously part of the general principles, it has now been given its own dedicated section, which covers all aspects from pre-conception through to the post-partum period to ensure comprehensive care throughout the reproductive stages.”
Selecting women who are directed to a Pregnancy Heart Team should be based on a risk assessment using the modified World Health Organization (mWHO) 2.0 classification. It is recommended that women with CVD of mWHO 2.0 class II–III and above are evaluated and managed by a Pregnancy Heart Team from pre-pregnancy onwards through pregnancy and post-partum. A discussion by the Pregnancy Heart Team about the high risk of maternal mortality or morbidity and the related high foetal risk is recommended for women with mWHO 2.0 class IV conditions. The previous Class III recommendations in this setting have been modified to a Class I recommendation, advising a model of shared decision-making and allowing women to make fully informed choices with appropriate psychosocial support. “We recognise the importance of a woman’s autonomy in making reproductive choices,” notes Prof. Haugaa. “The new guidelines promote a detailed and transparent dialogue about the heightened risks and encourage shared decision-making, with greater emphasis on the critical role of comprehensive counselling.”
The section on pregnancy in women with cardiomyopathies and primary arrhythmia syndromes has been expanded, with many new recommendations, and there is now a separate section on peripartum cardiomyopathy. Significant evidence has emerged in the context of heritable thoracic aortic disease, supporting a more gene- and variant-based approach, which has been incorporated into the section on aortopathies.
The section covering known congenital heart disease has undergone a major update based on recent reports, while pregnancy in women with pulmonary arterial hypertension is now covered in a separate section. Recommendations for emergency situations are provided for acquired heart diseases, including chest pain, arrhythmias, cardiac arrest, heart failure and hypertension. There are also new sections on cardio-oncology and heart transplantation.
One of the final sections reflects the growing recognition of the importance of adverse pregnancy outcomes (APO), covering aspects including gestational hypertensive disorders, pre-eclampsia, gestational diabetes mellitus, small or large for gestational age babies, or preterm birth. “It is recommended to undertake a CV risk assessment in women with APOs, to recognise and document APOs when CVD risk is evaluated in women, and to provide counselling on the importance of healthy lifestyle choices to optimise CV health,” says Prof. De Backer.
Prof. Haugaa concludes: “Post-partum care is often segmented and only carried out by obstetricians. A longer duration of post-partum care is likely to lower the long-term CVD risk in women with an APO. Seamless communication between the various healthcare providers (e.g. obstetrician, cardiologist, internist, family physician) and multidisciplinary management of APOs is critical for long-term care and the woman’s future health.”
Full details can be found in the European Heart Journal, with a condensed pocket version available on the free ESC Pocket Guidelines app.
References
- De Backer J, et al. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy. Eur Heart J. 2025. doi:10.1093/eurheartj/ehaf193.
