As maternal mortality continues to rise in the U.S., a comprehensive preconception risk assessment is crucial for women with heart failure (HF). HF and cardiomyopathy contribute to a high percentage of pregnancy deaths and multidisciplinary cardio-obstetric teams are necessary for improving maternal outcomes, according to a state-of-the-art review published Sept. 5 in JACC: Heart Failure.

Ersilia M. DeFilippis, MD, FACC, et al., discuss preconception counseling, risk stratification and management strategies for pregnant women with pre-existing or de novo HF extending to postpartum, the safety of HF medications during both pregnancy and lactation, and the management of women with left ventricular assist devices (LVADs) or after heart transplantation.

The authors note that “expert preconception counseling and appropriate risk stratification are necessary to provide individuals with the education and data needed for shared decision-making regarding the safety of pregnancy and potential outcomes,” and that using multidisciplinary cardio-obstetric teams to increase recognition and management of HF during pregnancy is vital in improving maternal outcomes. 

They also write that “there are unique considerations for different subtypes of cardiomyopathy as well as women desiring pregnancy while LVAD support or after heart transplantation” and indicate further studies should “include how pregnancy can change the natural history of cardiomyopathy and how to improve maternal health systems in the peripartum and postpartum periods.”