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Intervention is recommended before pregnancy in patients with MS and valve area <1.0 cm2. I C

Therapeutic anticoagulation using heparins or VKA is recommended in case of AF, left atrial thrombosis, or prior embolism. I C

Aortic stenosis

Intervention is recommended before pregnancy in patients with severe AS if they are symptomatic. I B Intervention is recommended before pregnancy in patients with severe AS if LV dysfunction (LVEF <50%) is present.204 I C

Intervention is recommended before pregnancy in patients with severe AS when they develop symptoms during exercise testing. I C

Chronic regurgitant lesions

Surgical treatment is recommended before pregnancy in patients with severe aortic or mitral regurgitation and symptoms, impaired ventricular function, or ventricular dilatation.204 I C

Medical therapy is recommended in pregnant women with regurgitant lesions when symptoms occur. I C

Recommendations for the management of prosthetic heart valves

It is recommended to choose the valve prosthesis in women contemplating pregnancy in consultation with a pregnancy heart team. I C

It is recommended to manage pregnancy in women with mechanical valves in a centre with a pregnancy heart team. I C

If delivery starts while on VKA or in less than 2 weeks after discontinuation of a VKA, caesarean section is indicated. I C

It is recommended to discontinue VKA and start adjusted-dose intravenous UFH (aPTT >_2 control) or adjusted-dose LMWH (see separate recommendations) at the 36th week of gestation. I C

It is recommended to anticipate the timing of delivery to ensure safe and effective peripartum anticoagulation. I C

Immediate echocardiography is indicated in women with mechanical valves presenting with dyspnoea and/or an embolic event. I C During the second and third trimesters until the 36th week, VKAs are recommended in women needing a low dose.a I C

Recommendations for the management of coronary artery disease ECG and measurement of troponin levels is recommended when a pregnant woman has chest pain.238 I C Primary coronary angioplasty is recommended as the preferred reperfusion therapy for STEMI during pregnancy.237 I C

Breastfeeding is not recommended in mothers who take antiplatelet agents other than low-dose aspirin due to a lack of data (see section 12). III C

Recommendations for the management of cardiomyopathies and heart failure

Anticoagulation is recommended in patients with intracardiac thrombus detected by imaging or with evidence of systemic embolism.286 I A

It is recommended to treat women with heart failure during pregnancy according to current guidelines for non-pregnant patients, respecting contraindications for some drugs in pregnancy130 (see Table 7). I B

It is recommended to inform women with HFrEF about the risk of deterioration of the condition during gestation and peripartum.29 I C

Therapeutic anticoagulation with LMWH or VKAs according to stage of pregnancy is recommended for patients with AF. I C

In HFrEF, it is recommended that beta-blockers are continued in women who used them before pregnancy, or that they are installed with caution if symptoms persist. I C

In patients with PPCM and DCM, counselling for recurrence risk during subsequent pregnancy is recommended in all cases, even after recovery of LV function. I C

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