Counselling and genetics

Inputs

mWHO 2.0 class (optional; see the mWHO 2.0 look-up)

Output

It is recommended to perform a risk assessment in all women with CVD of childbearing age using the mWHO 2.0 classification.Guideline rec

Class ILevel CRec Table 1 · §4.2 · p.4483

^c The mWHO 2.0 classification is the updated mWHO classification from the 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy

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It is recommended that women with CVD of mWHO 2.0 class II–III and above are evaluated and managed by a Pregnancy Heart Team from pre-pregnancy onwards through pregnancy and post-partum.Guideline rec

Class ILevel CRec Table 1 · §4.2 · p.4483

^c The mWHO 2.0 classification is the updated mWHO classification from the 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy

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Pre-conception (Figure 2)

Risk assessment mWHO 2.0
Genetic counselling
Lifestyle counselling
Reproductive technology
Drug review
Clinical optimization
Contraception

Figure 2, printed p4476 [FIG]

Women should receive pre-pregnancy counselling and education about the maternal, foetal, and transmission risk(s). In adolescents diagnosed with congenital or inherited heart disease, tailored discussions about reproductive health should start early, ideally from menarche. Girls and women with congenital heart disease may not demonstrate appropriate understanding of safe contraception and pregnancy risk. High rates of unintended pregnancies (up to 45%) have been reported in adolescents with congenital heart disease. Transition programmes showed improved disease-related knowledge levels in adolescents with congenital heart disease.
No class printed
§4.2, printed p4475 [TXT]

A personalized pregnancy-related risk assessment is needed in all women with CVD and should encompass the specific cardiovascular diagnosis, functional status, and medication regimen, as well as non-cardiac risk factors such as maternal age, smoking history, comorbidities, body mass index (BMI), obstetric history, logistical care aspects, maternal ethnicity, and socioeconomic status. It is also crucial to integrate foetal and obstetric outcomes with specific cardiovascular considerations.
No class printed
§4.2.1, printed p4475 [TXT]

Figure 4's yield ranges and impact grades are figure-only; no recommendation or text gives them.
Table 8 prints contraceptive efficacy as +, ++ and +++ without defining the scale.
Table 8 combines 'cautious use' and 'contraindications' in one column, so the page says a feature is 'listed under cautious use and contraindications' and never says which of the two applies. A method not listed for a feature is not shown as safe for it.
§4.2.5 says 'It is strongly recommended to consider and discuss termination…' in the text; the matching Rec Table 1 row (Class I, Level C) is worded differently and is shown beside it.

Educational summary of the 2025 ESC Guidelines. It does not replace clinical judgement or local protocol.

Pending physician review: this page has not yet been signed off by a named reviewer. · Reviewer: — (placeholder) · Reviewed: — · Content version 0.1.0-draft · 2025 ESC Guidelines (Eur Heart J 2025;46:4462–4568)