What work-up do we need for women with congenital heart disease in the 21st century for the preparation of pregnancy?

Pregnancy poses significant risks for women with congenital heart disease (CHD) due to major cardiovascular changes that can lead to complications which increases the morbidity and mortality rate in these patients. CHD is the leading cause of pregnancy-related deaths in the United States. In this review, we present the steps required to reduce these risks. We cover the changes to the maternal cardiovascular system that occur in pregnancy, and how they can significantly impact the cardiac patient where the disease may lead to poor adaptation in pregnancy. We discuss the epidemiology of this growing challenge and analyse the available the risk stratification models necessary to recognise and mitigate the chance of maternal cardiovascular complications arising in pregnancy. We follow on to discuss the necessity of pre-pregnancy counselling, which is often missed, but allows the potential mother to have a full conversation regarding the implication of pregnancy on her and her baby. We highlight the need to cover topics such as contraception, medication, subfertility, and maternal and fetal risk. Finally, we discuss the need of a pregnancy heart team; what specialist should be involved in the care of these high-risk women and where antenatal and delivery care should take place.