New patient guidelines help women with heart disease navigate pregnancy decisions

Francoise Steinbach was pregnant when doctors discovered a large aortic aneurysm. They told her she might need to terminate the pregnancy. Then they left her and her husband alone to decide.

"No one explained what was happening and no support whatsoever was offered," Steinbach recalled. "On the day of the medical abortion itself no one talked to me and I felt so alone and desperate."

Steinbach, who has Marfan syndrome (a genetic condition associated with heart problems), is now a member of the European Society of Cardiology's Patient Forum. She co-authored the new patient guidelines published on International Women's Day, March 8, 2026, with the explicit aim of ensuring no woman faces those decisions without information and support.

What the guidelines recommend

The patient version of the ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy translates the 2025 clinical guidelines into accessible language. The core recommendations address three phases: before pregnancy, during pregnancy and delivery, and after birth.

For women whose cardiovascular condition makes pregnancy high-risk, the guidelines recommend evaluation and management by a Pregnancy Heart Team from the moment they wish to start a family. This specialized team includes, at minimum, a cardiologist, anesthesiologist, midwife, obstetrician, and clinical nurse specialist. Depending on the condition, the team may expand to include geneticists, intensive care specialists, or surgeons.

Research cited in the guidelines associates Pregnancy Heart Team management with lower maternal death rates and fewer hospital readmissions. Yet referral remains inconsistent. "Too often women who would benefit from care by a specialised Pregnancy Heart Team are not referred in time," said Professor Kristina Hermann Haugaa, co-chair of both the clinical and patient guidelines.

Delivery planning and mental health

The guidelines recommend that healthcare teams develop a personalized delivery plan with each patient through shared decision-making. The plan should define whether labor will be induced, how delivery will be managed, and what postpartum monitoring the mother needs.

Vaginal delivery is encouraged for most women with cardiovascular disease, since complications from vaginal birth are generally lower than from cesarean section. Cesarean delivery may be recommended in specific clinical situations.

After delivery, the guidelines call for regular mental health screening. Depression affects 10 to 20% of new mothers in the general population, and the risk increases with underlying health conditions. For women who have navigated high-risk pregnancies with cardiovascular disease, the psychological toll can be substantial -- something Steinbach's experience illustrates starkly.

Why this matters now

The number of pregnant women with cardiovascular disease is growing globally. More women born with congenital heart disease are surviving to childbearing age. Maternal age at first pregnancy continues to rise in many countries, bringing higher rates of acquired cardiovascular conditions. And more women who have undergone transplants or cancer treatment are considering pregnancy.

The statistics are sobering. Maternal cardiovascular disease is now the leading cause of non-obstetric death in pregnant women, accounting for 33% of pregnancy-related deaths worldwide. Of those deaths, 68% are considered preventable. Up to 4% of pregnancies globally are complicated by cardiovascular disease, rising to 10% when hypertensive disorders are included.

Pregnancy places significant demands on the cardiovascular system. From the sixth week, stroke volume and cardiac output increase by 30 to 50%, and heart rate rises by 10 to 20 beats per minute. In women with existing heart disease, these adaptations can trigger heart failure or dangerous arrhythmias.

Accessible guidance, not a replacement for clinical care

Patient versions of ESC Guidelines are not intended to replace clinical consultation. They are designed to help women understand their options, ask informed questions, and participate more actively in decisions about their care. The distinction matters: shared decision-making requires that patients have access to the same evidence base that informs clinical recommendations, presented in language they can act on.

The guidelines were developed by an international panel including clinicians from Belgium, Norway, and the UK, alongside patient representatives. They are available online through the ESC website.

Whether these guidelines change outcomes will depend on how effectively they reach the women who need them and whether healthcare systems implement the Pregnancy Heart Team model the guidelines endorse. The evidence suggests the model works. The challenge is making it standard practice rather than the exception.