Cited by 474Cardiovascular Issues in PregnancyPregnancy and preeclampsia studiesCOVID-19 Impact on Reproduction

Cardiovascular considerations in caring for pregnant patients: a scientific statement from the American Heart Association

Open access
Mehta, Laxmi S., Warnes, Carole A., Bradley, Elisa, Burton, Tina, Economy, Katherine, Mehran, Roxana, Safdar, Basmah, Sharma, Garima +4 more·2020·Circulation

Abstract

Cardio-obstetrics has emerged as an important multidisciplinary field that requires a team approach to the management of cardiovascular disease during pregnancy. Cardiac conditions during pregnancy include hypertensive disorders, hypercholesterolemia, myocardial infarction, cardiomyopathies, arrhythmias, valvular disease, thromboembolic disease, aortic disease, and cerebrovascular diseases. Cardiovascular disease is the primary cause of pregnancy-related mortality in the United States. Advancing maternal age and preexisting comorbid conditions have contributed to the increased rates of maternal mortality. Preconception counseling by the multidisciplinary cardio-obstetrics team is essential for women with preexistent cardiac conditions or history of preeclampsia. Early involvement of the cardio-obstetrics team is critical to prevent maternal morbidity and mortality during the length of the pregnancy and 1 year postpartum. A general understanding of cardiovascular disease during pregnancy should be a core knowledge area for all cardiovascular and primary care clinicians. This scientific statement provides an overview of the diagnosis and management of cardiovascular disease during pregnancy.

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Integrity signals

Registry

Crossref · 10.1161/cir.0000000000000772

Cites

144 of 144 references verified0 citation errors · 0 not checkable

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  • Support from an interdisciplinary team can be particularly effective for facilitating lifestyle modification and weight loss.

    “Support from an interdisciplinary team that may include nutritionists, kinesiologists, pharmacists, and mental health specialists, in addition to obesity medicine specialists, can be particularly effective for facilitating lifestyle modification and weight loss.17,18”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [18]

    The ‘Hypertensive Disorders in Pregnancy’ section recommends a multidisciplinary strategy that includes lifestyle and behavioral changes such as diet and exercise. It does not say that interdisciplinary support is particularly effective for weight loss, or identify the specialists listed in the citing sentence. (LLM, conf=0.84)

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  • More timely initiation of therapy is associated with improved cardiovascular clinical outcomes among individuals with hypertension, diabetes, and dyslipidemias.

    “More timely initiation of therapy is associated with improved cardiovascular clinical outcomes among individuals with hypertension, diabetes, and dyslipidemias.18,53”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [18]

    The “Hypertensive Disorders in Pregnancy” section recommends treatment within 30–60 minutes of confirmed severe hypertension to reduce maternal cardiovascular risks. This supports the claim only for severe hypertension in pregnancy; the paper does not establish that earlier therapy improves cardiovascular outcomes for people with diabetes or dyslipidemia. (LLM, conf=0.86)

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  • Recent evidence suggests that counseling related to risk reduction for CKM syndrome in high-risk women should start in the prenatal period and continue until the completion of postpartum follow-up visits for the mother and baby.

    “However, recent evidence suggests that counseling related to risk reduction for CKM syndrome in high-risk women should start in the prenatal period and continue until the completion of postpartum follow-up visits for the mother and baby.16–18”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [18]

    The paper’s pre-pregnancy counseling discussion recommends counseling women with cardiovascular disease, and its Clinical Statements and Guidelines section recommends fourth-trimester follow-up, risk-factor modification, and discussion of future cardiovascular risk after adverse pregnancy outcomes (page not available in our copy). It does not specify CKM syndrome risk-reduction counseling or say that counseling should continue until both mother and baby complete postpartum follow-up visits. (LLM, conf=0.84)

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  • Despite the lack of CVD event reduction, lifestyle modification with behavior change, healthy dietary modification, and physical activity, resulting in weight loss of 5% to 10%, causes improvements in CKM risk factors including remission of T2D, with the CKM benefits of lifestyle modification observed across a range of populations and geographic settings.

    “Despite the lack of CVD event reduction, lifestyle modification with behavior change, healthy dietary modification, and physical activity, resulting in weight loss of 5% to 10%, causes improvements in CKM risk factors including remission of T2D,17,18 with the CKM benefits of lifestyle modification observed across a range of populations and geographic settings.19”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [18]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

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  • Dysregulation of pregnancy changes leading to excess insulin resistance, adipose deposition, hypercoagulability, cardiac remodeling, and decreased vascular resistance may result in APOs.

    “dysregulation of these changes leading to excess insulin resistance, adipose deposition, hypercoagulability, cardiac remodeling, and decreased vascular resistance,12,18 may result in APOs.”

    From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [18]

    The paper describes left-ventricular structural changes and declining systemic vascular resistance during pregnancy (opening physiology passage; page unavailable), and hypercoagulability during pregnancy (Clinical Statements and Guidelines; page unavailable). It also discusses adverse pregnancy outcomes, but attributes their shared pathways to placental dysfunction and oxidative stress. Our copy does not link dysregulation of the listed changes to APOs or address excess insulin resistance and adipose deposition in that account. (LLM, conf=0.86)

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Cites

Flagged first, then by citations

1 of the 145 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [11]11. ACOG Practice Bulletin No. 202: gestational hypertension and preeclamp- sia. Obstet Gynecol. 2019;133:e1-e25.
  2. [15]15. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep. 2018;67:1-50.
  3. [77]77. Thorne S. Risks of contraception and pregnancy in heart disease. Heart. 2006;92:1520-1525.

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Authors
Mehta, L. S., Warnes, C. A., Bradley, E., Burton, T., Economy, K., Mehran, R., Safdar, B., Sharma, G., Wood, M., Valente, A. M., Volgman, A. S., & On behalf of the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, T. A. V. B. C. O. C. A. S. N. A. S. C.
Venue
Circulation
Published
2020-06-09
Volume
141
Issue
23
Pages
e884-e903
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
OpenAlex
W3022591273
Cited by
464
References
145
Citations by year
2026: 96 · 2025: 69 · 2024: 70 · 2023: 81 · 2022: 75 · 2021: 56 · 2020: 17
FWCI
9.71
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Issues in Pregnancy
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
Keywords
cardiovascular disease in pregnancy, cardio-obstetrics, maternal mortality, hypertensive disorders of pregnancy, preeclampsia, hypercholesterolemia, myocardial infarction, cardiomyopathy, cardiac arrhythmias, valvular heart disease, thromboembolism, aortic disease, cerebrovascular disease, preconception counseling, maternal morbidity, postpartum care
MeSH terms
American Heart Association, Female, Humans, Postnatal Care, Pregnancy, Pregnancy Complications, Cardiovascular, United States, Delivery, Obstetric

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