Insights into the 2025 ESC guidelines for the management of cardiovascular disease and pregnancy

Abstract

The 2025 ESC guidelines for the management of cardiovascular disease and pregnancy1 address the need for an updated review of the previous recommendations. A special effort has been made to provide clear information, supported by summary tables, graphical abstracts, and flow charts that enhance clinical applicability. Cardiovascular disease (CVD) is now the leading cause of nonobstetric mortality in pregnant women,2 with a rising incidence of acquired heart disease. There is striking evidence linking adverse pregnancy outcomes (APO) to a patient’s future cardiovascular risk. Growing data have emerged regarding the risks for both the mother and the foetus during pregnancy and postpartum, as well as the use of medications during preconception, pregnancy, and lactation. Consequently, the new guidelines include an updated risk stratification system (mWHO 2.0) for different cardiac conditions and integrate information on genetic counselling and risk assessment tools.3 Research supports the benefits of a multidisciplinary approach in these patients. As a result, there is a growing emphasis on the establishment of Pregnancy Heart Teams (PHT) as a central component of care. Finally, contemporary cardiovascular care in pregnancy reflects a shift away from paternalistic models toward patient-centered approaches, in which autonomy is prioritized through joint and informed decision-making.