ESC launches guidelines for patients to empower women with CVD to make informed pregnancy health decisions

Key takeaways

• A new patient version of ESC Guidelines on pregnancy is being published on International Women's Day to empower women living with cardiovascular disease to make informed decisions about pregnancy and birth and support shared decision making with clinical staff.
• The patient guidelines give accessible information about medical and psychological support options available to women with pre-existing cardiovascular disease before, during and after birth.
• The guidelines also state that Specialist Pregnancy Heart Teams should support women at high risk from the moment they want to start a family, through pregnancy and delivery, and after delivery.
• The new patient version of the guidelines are based on the 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy[1].
• Sixty-eight percent of pregnancy-related deaths caused by cardiovascular disease are preventable.

Sophia Antipolis, 8 March 2026: A new patient version of ESC Guidelines[2], published on International Women's Day, aim to empower women living with cardiovascular disease to make informed decisions about pregnancy and birth and support them to be more involved in shared decision making.

Françoise Steinbach, an ESC Patient Forum member and co-author of the clinical guidelines and the new patient version said: "Being pregnant while having cardiovascular disease causes additional stress and anxiety, and the mother has to take care of her own health as well as preserving the growth and health of her unborn child."

"These new guidelines explain what a woman with cardiovascular disease should do to prevent problems throughout her pregnancy, and to give information about the period after birth and long-term maternal care. For those with genetic cardiac conditions, the guidelines also give advice about pre-pregnancy counselling so women can make well-informed decisions," she continued.

The patient guidelines recommend that women with cardiovascular disease that makes their pregnancy high risk, are evaluated and managed by a Pregnancy Heart Team from the moment they wish to start a family through to pregnancy and delivery, and after delivery.

Pregnancy Heart Team management is associated with lower maternal death rates, lower hospital readmission rates and resulting improved patient safety. The core Pregnancy Heart Team includes a cardiologist, anaesthesiologist, midwife, obstetrician and clinical nurse specialist. Depending on the clinical problem, the team could be expanded to include other healthcare professionals, for example, a general practitioner, surgeon, intensive care specialist and genetic counsellor.

"Too often women who would benefit from care by a specialised Pregnancy Heart Team are not referred in time. Conversely, some women are referred unnecessarily, thereby putting strain on these services. This guidance clearly defines which women should receive care from a Pregnancy Heart Team," Prof. Kristina Hermann Haugaa, co-chair of the clinical guidelines and the patient version and Head of the Outpatient Clinic and Unit for Genetic Cardiac Diseases at Department of Cardiology, Oslo University Hospital and University of Oslo explained.

The guidelines also advise that the healthcare team should work in a shared decision making process with the woman to develop a personalised delivery plan. The plan should define whether labour should be induced, how labour and birth should be managed, and what monitoring the mother may need after the baby is born.

Vaginal delivery should be encouraged for most women with cardiovascular disease because complications associated with vaginal birth are generally lower, according to the guidance. A caesarean section may nonetheless be recommended in some specific situations.

After birth, the guidance recommends that women with cardiovascular disease receive regular mental health screening by their healthcare team so that any problems are identified early and tailored support given. They note that the risk of developing depression among new mothers in the general population is about 10-20% and this risk increases with underlying health conditions such as cardiovascular disease.

"As someone who has cardiovascular conditions myself, and having had two pregnancies, I know how important these guidelines are. I feel particularly strongly about the need for psychological support and shared decision making for pregnant women affected by cardiovascular disease," explained Françoise Steinbach, who herself has a health condition called Marfan Syndrome which is associated with heart problems. She had a child before she was diagnosed, but during a second pregnancy she was diagnosed with a very large aortic aneurysm which required heart surgery while pregnant.

Doctors told her that she would have to think about terminating her pregnancy. "My husband and I were left alone to make the decision, no one explained what was happening and no support whatsoever was offered. On the day of the medical abortion itself no one talked to me and I felt so alone and desperate - it was the most traumatising episode of my whole medical journey. I hope that no woman has to go through such an ordeal ever again. Women in this situation need more humanity and empathy and must be offered psychological support to them and their partner."

Globally, the number of pregnant women with cardiovascular disease is growing. This is due to a number of factors, such as higher maternal age at first pregnancy, a growing number of women with congenital heart disease reaching childbearing age, and a rising prevalence of cardiovascular comorbidities.

Professor Julie De Backer, co-chair of the clinical guidelines and the patient version and Cardiologist and Clinical Geneticist from the Department of Internal Medicine and Paediatrics at Ghent University said: "More women with known cardiovascular disease are considering pregnancy. This is for many reasons such as more women who were born with heart conditions are surviving to adulthood, a greater number of women who have had a transplant or cancer treatment, and more women with acquired heart disease. This guidance gives clinicians and patients clear, and accessible advice based on the latest evidence."

Maternal cardiovascular disease is now the leading cause of non-obstetric mortality in pregnant women, accounting for 33% of pregnancy-related deaths worldwide. Sixty-eight percent of pregnancy-related deaths caused by cardiovascular disease are preventable. Up to 4% of pregnancies are complicated by cardiovascular disease globally, rising to 10% when including high blood pressure disorders. Reducing maternal mortality and morbidity is a key priority of the World Health Organization (WHO).

Pregnancy is a high-risk period for women with cardiovascular disease, due to the physiological changes in the heart and blood system needed to meet the increased metabolic needs of the mother and foetus. From the sixth week of pregnancy stroke volume and cardiac output increase in women by 30%-50%, and heart rate increases by 10-20 beats per minute. In women with heart disease, the adaptations needed from the heart can be faulty and can lead to heart failure and atrial and ventricular tachyarrhythmias.

ENDS