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Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association
Open accessAbstract
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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In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adverse CKM risk factor levels (overweight/obesity, hypertension, hypertriglyceridemia, diabetes, CKD) during the prepregnancy period are associated with increased risk of APOs.18,29”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“While waist-hip ratio provides improved characterization of metabolic and cardiovascular risk than waist circumference, challenges of complexity of measurement and lack of standardization make it less ideal for use in clinical settings.18,29–32”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Using both BMI and waist circumference provides complementary prognostic information regarding risk for future metabolic derangements, incident CVD, and mortality.”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Regular assessments of lipids, glycemia, and kidney function (eg, eGFR) are recommended with increasing frequency for higher CKM stages, as the risk for progressive metabolic and kidney disease increases along the CKM spectrum.13,18–21”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Through these mechanisms, adverse SDOH lead to CKM risk factor development.16–20”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Modest weight loss of 5% to 10% among patients with overweight or obesity and diabetes is associated with improvement in glycemic measures, BP, HDL-C, and triglycerides, among others. This can result in risk reduction for incident CKM risk factors such as diabetes and hypertension.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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Average excess weight loss is greater with RYGB (56%) than LSG (46%),2,18 with persistent differences at 10 years.4”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Bupropion/naltrexone, phentermine/topiramate, and orlistat have all shown efficacy in improving glycemia, and the latter 2, in reducing BP.”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Clinical trials have indicated a lack of heterogeneity in the effects of each class of these cardioprotective glucose-lowering therapies between those who were and were not taking the other agent.17–19,21”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In patients with symptomatic PAD, semaglutide increases walking distance.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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Treatment of obesity-related HFpEF with the GLP-1–based therapies semaglutide and tirzepatide achieves improvements in HF patient-reported health status and quality of life, functional capacity as measured by the 6-minute walk distance (6MWD), and freedom from worsening HF events, including HF hospitalizations.1,3,17,18”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“One analysis was based on the results of the EMPEROR-PRESERVED trial, in which the effect of SLGT2i on cardiovascular mortality in HFpEF was not statistically significant (HR, 0.91; 95% CI, 0.76–1.09).”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Two high-quality simulation model–based cost-effectiveness analyses evaluated the economic value of adding SGLT2i therapy to prior GDMT in adults with symptomatic HFpEF, but neither study reported subgroup analyses by diabetes status.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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In a sensitivity analysis assuming a 9% cardiovascular mortality benefit, the ICER was $174 053 per QALY gained.”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Prior studies performed using a US health care sector perspective and a lifetime analytic horizon noted that SGLT2i therapy was unlikely to be cost-effective for HFpEF, but that the incremental cost-effectiveness ratio was sensitive to the effect on mortality.”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“These analyses suggest that SGLT2i therapy is not cost-effective at current drug prices (incremental cost-effectiveness ratio ≥$120 000 per QALY gained), but these analyses pooled individuals with and without diabetes, and there may be additional cardiovascular and kidney benefits in individuals with diabetes.”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Fibrosis stage best predicts adverse outcomes in MASLD.1,18”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“a lower eGFR, higher UACR, and higher CKD stages are associated with VTE development and worse outcomes.16–20”
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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Women planning pregnancy with diabetes are at greater risk of experiencing APOs compared to women without diabetes or those who develop GDM.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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“An effective response to obesity pharmacotherapy has historically been described as at least 5% of body weight loss after 3 months of treatment.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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“MBS, which induces body weight loss of >20%, also improves OSA, and is associated with reductions in CV and renal events, and in cardiovascular and all-cause mortality among people with OSA.3,18”
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]
Experimental — accuracy not yet measured
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Special Considerations for Lipid-Lowering Therapy in Women Reflecting Recent Randomized Trials
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Self-citationEffects of Mindfulness-Based Interventions on Cardiometabolic-Related Adverse Pregnancy Outcomes
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Breastfeeding and maternal exercise: A synergistic approach to improve cardiometabolic health
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The Outcomes of PBMV in Pregnancy, and When is the Best Time?
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Acute Myocardial Infarction in Pregnancy
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Optimizing reproductive health management in lupus and Sjogren's syndrome
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Prenatal Arsenite Exposure Alters Maternal Cardiac Remodeling During Late Pregnancy
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Management of Ischemic Heart Disease in Pregnancy
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RetractedMarshall, W. H., V, Gee, S. E., Lim, W., Lastinger, L. T., Cackovic, M., Benza, R. L., Daniels, C. J., Bradley, E. A., & Rajpal, S. (2022) · International Journal of Cardiology Congenital Heart Disease · doi:10.1016/j.ijcchd.2022.100354 · Cited by 4
Self-citationSpontaneous Coronary Artery Dissection
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Metadata
- 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.
- ORCID
- Venue
- Circulation
- Published
- 2020-06-09
- Volume
- 141
- Issue
- 23
- Pages
- e884-e903
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W3022591273
- Semantic Scholar
- a4f99c537a938a755723900351845a99644d8796
- 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
- Update notices
- Open access
- bronze
- doi.org
- 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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