Navigating women with congenital heart disease during pregnancy: Management strategies and future directions

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.