Das BB, Aggarwal V, Deshpande SR. Navigating women with congenital heart disease during pregnancy: Management strategies and future directions. World J Cardiol 2025; 17(6): 106295 [DOI: 10.4330/wjc.v17.i6.106295]
Corresponding Author of This Article
Bibhuti B Das, MD, MBA, MHA, FACC, Congenital Heart Institute, Methodist Children’s Hospital, 7700 Floyd Curl Dr, San Antonio, TX 78229, United States. bbdas001@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Evidence Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Jun 26, 2025; 17(6): 106295 Published online Jun 26, 2025. doi: 10.4330/wjc.v17.i6.106295
Navigating women with congenital heart disease during pregnancy: Management strategies and future directions
Bibhuti B Das, Varun Aggarwal, Shriprasad R Deshpande
Bibhuti B Das, Congenital Heart Institute, Methodist Children’s Hospital, San Antonio, TX 78229, United States
Varun Aggarwal, Department of Pediatrics, University of Minnesota Medical School, University of Minnesota Medical School, Minneapolis, MN 55454, United States
Shriprasad R Deshpande, Department of Pediatric Cardiology, Children's National Hospital, The George Washington University, Washington, DC 20010, United States
Author contributions: Das BB curated the literature, first draft, revision, and editing; Aggarwal V curated data, edited manuscript, prepared tables; Deshpande SR curated data, edited, and revised the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bibhuti B Das, MD, MBA, MHA, FACC, Congenital Heart Institute, Methodist Children’s Hospital, 7700 Floyd Curl Dr, San Antonio, TX 78229, United States. bbdas001@gmail.com
Received: February 24, 2025 Revised: April 8, 2025 Accepted: May 21, 2025 Published online: June 26, 2025 Processing time: 119 Days and 2.7 Hours
Abstract
Women with adult congenital heart disease (CHD) face unique challenges during pregnancy, as gestational cardiovascular (CV) and hemodynamic changes can exacerbate underlying cardiac conditions. While these adaptations are well tolerated in women with structurally and functionally normal hearts, they pose significant risks for those with adult CHD (ACHD), whether repaired, palliated, or with residual defects. Maternal CHD is associated with an increased risk of adverse CV events, including stroke, heart failure, arrhythmias, and thromboembolic complications during pregnancy and the peripartum period. Effective management requires a multidisciplinary team, including cardiologists, perinatologists, anesthesiologists, and other skilled care providers. Risk stratification tools such as the modified World Health Organization classification, CARPREG II, and ZAHARA scores are useful for predicting maternal and fetal outcomes and guiding clinical decision-making. Preconception counseling plays a critical role in assessing individual risks, optimizing cardiac function, and educating patients about potential complications. Future research should prioritize innovative therapies, including targeted pharmacological agents and minimally invasive interventions, alongside improved screening methods to identify high-risk patients before symptomatic disease manifests. This review synthesizes current literature on managing pregnant women with ACHD, highlights gaps in clinical practice, and explores future directions to enhance care. Addressing these challenges is essential to improving maternal and fetal outcomes and ensuring comprehensive, patient-centered care throughout the reproductive journey.
Core Tip: Managing adult congenital heart disease (ACHD) in pregnancy requires a multidisciplinary approach. Preconception counseling, risk stratification with the modified World Health Organization classification, and tailored monitoring optimize maternal and fetal outcomes. Hemodynamic changes can worsen ACHD complications, necessitating specialized cardio-obstetric team care. Individualized delivery plans, vigilant postpartum surveillance, and post-delivery contraception counseling are essential. Advances in imaging and interventions improve outcomes, but high-risk cases demand tertiary center expertise to address cardiac decompensation, arrhythmia, or heart failure, ensuring safe pregnancy management. Future directions emphasize AI-driven risk prediction to further enhance outcomes.
