Multidisciplinary Care in Pregnancy for Women With Cardiovascular Disease

Cardiovascular disease (CVD) in pregnancy presents unique challenges that demand coordinated care across specialties.Using a team approach with cardiologists, obstetricians, anesthesiologists, nurses, pharmacists, and social workers to manage risk in preconception, pregnancy, delivery, and post-delivery periods can help achieve better outcomes. Pregnancy increases pressure on the circulatory system. Therefore, women with heart conditions prior to pregnancy or acquired through pregnancy are particularly at risk. The heart team can help manage their care and prevent avoidable emergencies.

Why It Matters

Pregnancy puts extraordinary demands on the heart and blood vessels. Increased volume of blood, increased heart rate, and increased metabolic rate of the body become common. Normal physiologic changes can bring into light any abnormality in the heart or worsen a preexisting problem with the heart. A person suffering from mild cardiomyopathy might suffer from heart failure due to pregnancy, and even pre-eclampsia may lead to great cardiac overload.

Sometimes there may be certain important things that can be overlooked. The cardiologist is responsible for handling medicines and the condition of the heart; the obstetrician is responsible for monitoring the condition of the baby and planning the birth process. The anesthesiologist is working on how to stabilize blood pressure at delivery time; the social worker is helping families implement their care plans. All these specialists will work according to one strategy; thus, the health of both mother and the baby will be protected.

Pregnancy is also a window into lifelong heart health. Many serious conditions first appear during pregnancy or shortly after delivery. Peripartum cardiomyopathy (cardiac dysfunction that develops later in pregnancy or after delivery), new arrhythmias, and others fit into this category. Complications such as hypertensive conditions and arrhythmia during pregnancy usually indicate an increased probability of having heart attacks and strokes in the future. Thus, if the clinician tracks a woman’s cardiovascular system carefully during this period, he/she will be able to address any persisting problems early on.

Who It Affects

Anyone who already has heart disease and plans to get pregnant requires this type of care. This is true whether they have congenital heart defects (whether surgical correction occurred), valve disease, cardiomyopathy, coronary artery disease (with history of prior heart attacks), or even mechanical heart valves. Those who suffer from significant lung or kidney disease which puts stress on their heart must also be considered. Moreover, pregnancy may itself cause new diseases such as hypertensive and pulmonary hypertension.

Healthcare professionals would also be effected by this change. Specialists in maternal-fetal medicine (also called high-risk obstetricians), along with general obstetricians, collaborate with cardiologists with experience in pregnancy conditions. Anesthesiologists devise strategies regarding pain management and blood pressure control during delivery. In addition, neonatologists are ready to care for the infant if required. The contributions of non-physicians on these teams are also essential, including nurses and nurse practitioners educating patients on symptoms and medications, as well as pharmacists assessing drug safety and doses.

Healthcare systems and insurance companies also play an important role. Indeed, high-risk pregnancies are resource intensive: extra doctors’ appointments, additional tests and consultations increase the cost. However, coordinated care is capable of avoiding even more costly complications. Women who are part of good cardiac-obstetric programs have fewer admissions to ICU, less surgery and re-hospitalizations. Eventually, the burden will decrease on the side of healthcare providers, and the payments will be reduced for the payers.

What Changes

• Preconception counseling: Patients with cardiovascular diseases should see a cardiologist and an obstetrician (or maternal-fetal medicine specialist) prior to pregnancy. Both will evaluate the patient’s condition and the risks of pregnancy and will modify her treatment plan accordingly, for instance by discontinuing or substituting some medications for high blood pressure and high cholesterol. In addition, the two physicians will devise a contraception and conception plan – at times postponing pregnancy will be more favorable.

• Risk stratification: Once pregnancy starts, the risk of that woman will be categorized according to her heart problem and the general health of the patient. There are methods such as the use of modified WHO risk categorization system or CARPREG scoring system. Low-risk patient is managed in a routine prenatal clinic with enhanced surveillance like further ultrasounds and echocardiography while high-risk patients need to deliver in a place where there are facilities for heart and intensive care unit.
• Medication management: Pregnant women should choose their heart medicines wisely. While some are safe (such as beta blockers and diuretics), others can be harmful to the pregnant woman or her child. For instance, patients with a mechanical heart valve are advised to switch from warfarin to heparin before childbirth, as warfarin is toxic to the growing fetus. The whole heart medical team, including a pharmacist, ensures that the right drugs are administered to the pregnant lady and that she knows what medicine can be taken safely when breastfeeding.
• Postpartum follow-up: However, the risk of developing health issues persists after delivery, at least during the first weeks after birth. These days, medical professionals have started scheduling a consultation with a cardiologist just after giving birth (usually within one to two weeks) so that any problems can be noticed earlier on. Additionally, the person taking care of her in the future after delivery is determined.
• Building these programs also means changing how care is delivered. In many hospitals, obstetric services are segregated (obstetric services being handled by one department, cardiology in another). The perinatal heart team is about breaking down such barriers. It usually takes a good leader to put into place a system of jointly conducted clinics, frequent meetings, and a common care plan for all patients. The teams that do so say that they have better handovers when the time comes for delivery.
• Real-life decisions often involve hard trade-offs. For instance, consider the case of a pregnant lady who has an artificial valve of her aorta. In such a case, there are chances of clotting of the valve, which may lead to a stroke if she does not take any blood thinners. However, the use of a high strength blood thinner increases the probability of excessive bleeding at childbirth. Here again, a multidisciplinary team needs to come up with the best decision, say changing warfarin to heparin in the later stages of pregnancy among others.
• Access is a persistent problem. Perinatal cardiology is mainly provided by specialized facilities. Patients living in rural or other areas may need to travel for hours or find problems with insurance to seek care. The development of telemedicine has been of great help since cardiologists are able to consult remotely, examine images remotely, and see patients virtually. However, some procedures cannot be done remotely, and delivery has to take place at an adequately equipped hospital. Filling the gap will require insurance to cover travel expenses and support telemedicine.
• Training and staffing are hurdles, too. Many cardiologists receive little training in pregnancy-specific heart care, and many obstetricians see only a few such cases. Fellowships and further education opportunities in the field of cardio-obstetrics are growing, although their numbers are small. As more and more people learn about it, the number of practitioners with such experience will be growing. But right now there are some issues that should be addressed by hospitals – for instance, billing for a visit of two specialists.
• Looking ahead, there are clear opportunities to improve consistency and quality. Development of standard pathways for each type of illness will make sure that there are best practices in place. Networking of referral systems on a regional basis will ensure that each hospital is aware of the location and method for referral of high-risk individuals. Data collection through registry or quality programs will help in identifying which methods save lives. In addition, pregnancy is an opportunity to take steps toward good health; cardiovascular risk counseling (e.g., nutrition, blood pressure, or cholesterol) is integrated into regular OB practice.
• For clinicians, the key message is simple: don’t manage a pregnant patient with heart disease on your own. Engage the multidisciplinary heart team early. For health system leaders, the message is similar: support coordination with joint clinics, clear referral paths, and shared records. And for policymakers, consider payment models and programs that reward team-based care and support access to higher-level services when needed.

Ultimately, multidisciplinary care in pregnancy is not about creating more appointments. It is about aligning expertise to handle complex trade-offs, avoiding preventable crises, and treating each pregnancy as part of a woman’s long-term health journey. When teams work together, patients benefit from clearer plans, fewer surprises, and a smoother transition into life after delivery.

References

1. Mehta LS, Warnes CA, Bradley E, Burton T, Economy K, Mehran R, et al. Cardiovascular considerations in caring for pregnant patients: A scientific statement from the American Heart Association. Circulation. 2020. Direct link [\[ahajournals.org\]](https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000772?download=true)
2. Meng M-L, Arendt KW, Banayan JM, Bradley EA, Vaught AJ, Hameed AB, et al. Anesthetic care of the pregnant patient with cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2023. Direct link [\[ahajournals.org\]](https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000001121)
3. Lewey J, Beckie TM, Brown HL, Brown SD, Garovic VD, Khan SS, et al. Opportunities in the postpartum period to reduce cardiovascular disease risk after adverse pregnancy outcomes: A scientific statement from the American Heart Association. Circulation. 2024. Direct link [\[ahajournals.org\]](https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000001212)
4. Afari H, Sheehan M, Reza N. Contemporary management of cardiomyopathy and heart failure in pregnancy. Cardiology and Therapy. 2024. Direct link [\[pmc.ncbi.nlm.nih.gov\]](https://pmc.ncbi.nlm.nih.gov/articles/PMC10899150/)