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............................................................................... – with PAH – severe systemic ventricular dysfunction (EF <30% or NYHA class

III–IV). – severe (re-)coarctation – systemic right ventricle with moderate or severely decreased ventricular function – with vascular Ehlers-Danlos – with severe aortic dilatation or (history of) aortic dissection – with severe MS (even when asymptomatic) – Patients with severe AS who are symptomatic, or asymptomatic patients with impaired LV function or a pathological exercise test – if LVEF does not normalize in women with previous PPCM. • Women with a mechanical valve prosthesis are at high-risk of maternal morbidity (especially valve thrombosis and bleeding) and even mortality, and should be managed by a pregnancy heart team in expert centres. • LMWH should only be used when weekly monitoring of anti-Xa levels with dose adjustment is available. • Women with HF during pregnancy should be treated according to current guidelines for non-pregnant patients, respecting contraindications for some drugs in pregnancy (see table ‘Recommendations for drug use in pregnancy’). When inotropes or more advanced treatment is necessary, transport to an expert centre is recommended. • It is recommended to inform women with DCM and HFrEF about the risk of deterioration of the condition during gestation and peripartum. • In women with PPCM and DCM, subsequent pregnancy is not recommended if LVEF does not normalize. • Patients with congenital LQTS and catecholaminergic polymorphic VT are recommended beta-blockers during pregnancy and post-partum. • Initiation of antihypertensive drug treatment is recommended in all women with persistent elevation of BP >_150/95 mmHg and at values >140/90 mmHg in women with:

– gestational hypertension (with or without proteinuria) – pre-existing hypertension with the superimposition of gestational hypertension – hypertension with subclinical organ damage or symptoms at any time during pregnancy. • Women at high or moderate risk of pre-eclampsia should be advised to take 100–150 mg of acetylsalicylic acid daily from week 12 to week 36–37 in addition to their hypertension treatment. • Methyldopa, labetalol, and calcium antagonists are recommended for the treatment of hypertension in pregnancy. • LMWH is the agent of choice for VTE prophylaxis and treatment. • Thrombolytics to treat thrombo-embolism should only be used in patients with severe hypotension or shock. • In the case of an emergency, drugs that are not recommended by the pharmaceutical industry during pregnancy and breastfeeding should not be withheld from the mother. The potential risk of a drug and the possible benefit of the therapy must be weighed against each other. Downloaded from academic.oup.com/eurheartj/article/39/34/3165/5078465 by guest on 07 October 2026