Cardiovascular disease in pregnancy: physiology, global burden, risk stratification, and opportunities in care

Prof. K Sliwa, the Director of the Cape Heart Institute (CHI), is a co-author on a paper on cardiovascular disease in pregnancy published in The Lancet on 30 August 2026. This is the first paper of a three-part Series examining the continuum of cardiovascular risk surrounding pregnancy-pro preconception through to lifelong surveillance. This Series underscores pregnancy as a pivotal window into women’s lifelong cardiovascular health and calls for integrated, equitable strategies to prevent avoidable maternal and fetal complications, while substantially lowering the lifetime risk of cardiovascular disease across diverse populations.
 

Pregnancy poses a unique haemodynamic stress on women, with substantial metabolic and hormonal alterations that can often unmask underlying cardiovascular disease or precipitate de-novo cardiovascular disease; this paper focuses on the pathophysiological changes of high-risk cardiovascular disease, which are described as congenital heart disease, acquired pre-pregnancy cardiovascular disease, and new-onset cardiovascular conditions. The paper on Cardiovascular Disease in Pregnancy 1 highlights that there is a need for the implementation of screening protocols for all pregnant and postpartum women for early detection of cardiovascular disease, which includes patient-reported symptoms, vital signs, risk factors, and physical examinations, along with additional imaging (eg. echocardiograms), that helps distinguish between the typical physiological and haemodynamic changes of pregnancy versus cardiovascular disease and prompts clinicians to streamline care for these high-risk conditions.