Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy (2026)

Chapter: Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy

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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Appendix B

Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy

This appendix summarizes selected recommendations, clinical guidelines, and practice advisories from professional societies and other organizations relevant to cardiovascular health before, during, after, and between pregnancy (see Table B-1). This includes topics with the most relevance—it is not a complete compendium. In addition to major U.S. professional organizations, the table includes selected international guidance (e.g., National Institute for Health and Care Excellence) that is influential in clinical practice and frequently cited in U.S. guidance.

Table B-1 is organized into four sections. The first includes recommendations specific to cardiovascular conditions and pregnancy-related cardiovascular disease (CVD) complications; recommendations are grouped by condition and type of intervention (e.g., assessment, treatment threshold, medication therapy). The second section includes recommendations on life course cardiovascular risk, postpartum transition, and interpregnancy care, and the third section addresses other conditions and lifestyle factors relevant to CVD risk. The fourth section, included for context, summarizes recommendations on general maternity care.

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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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TABLE B-1 Selected Society, Organization, and International Guidance Relevant to Cardiovascular Disease Prevention Before, During, and After Pregnancy

Topic Life stage Type Issuing body/document (year) Key recommendations (concise summary)a
Specific to Cardiovascular Conditions and Pregnancy-Related Cardiovascular Disease Complications
Hypertensive disorders of pregnancy Prepregnancy–PP Risk reduction, assessment, management, follow-up NICE guideline: Hypertension in pregnancy (NG133) (updated 2023) (NICE, 2023)
  • Aspirin prophylaxis for women at high risk of preeclampsia and those with more than one moderate risk factor, using the NICE-specified dose range
  • Recommend PP BP monitoring (daily for the first 2 days; at least once days 3–5), follow-up at transfer to community care, and counseling on recurrence risk and increased long-term risk of HTN and CVD after HDP
Hypertensive disorders of pregnancy Prepregnancy–PP Diagnosis., management ISSHP: 2021 recommendations (Magee et al., 2022)
  • ISSHP-recommended classification and diagnostic criteria applied for HDPs, with guideline-based prevention, management, and PP follow-up
Chronic hypertension Prepregnancy–PP Assessment, management, medication ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy (2019) (ACOG, 2019a)
  • Diagnosing chronic HTN based on prepregnancy or early-pregnancy BP criteria
  • Management with individualized antihypertensive therapy and antenatal and PP monitoring
Gestational hypertension and preeclampsia PN–PP Diagnosis, management ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia (2020) (ACOG, 2020)
  • Diagnosing gestational HTN and preeclampsia using standardized clinical and laboratory criteria
  • Management based on disease severity and gestational age, with PP monitoring
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Chronic hypertension in pregnancy PN Treatment threshold/management update ACOG Practice Advisory: Clinical Guidance for the Integration of Chronic Hypertension and Pregnancy Study (April 2022) (ACOG, 2022)
  • BP threshold of 140/90 mmHg for initiation or titration of antihypertensive therapy, rather than waiting for severe-range HTN
Mild chronic hypertension in pregnancy PN Management recommendation SMFM Statement: Antihypertensive therapy for mild chronic hypertension in pregnancy (2022) (Society for Maternal-Fetal Medicine, 2022)
  • Initiation or titration of antihypertensive therapy at a BP threshold of 140/90 mmHg
Preeclampsia prevention PN Preventive medication (society advisory) ACOG/SMFM Practice Advisory: Low-dose aspirin to prevent preeclampsia (Dec 2021) (ACOG, 2021)
  • Low-dose aspirin prophylaxis for pregnant individuals at high risk of preeclampsia and those with more than one moderate risk factor, consistent with the updated USPSTF risk-based framework
Hypertensive disorders of pregnancy postpartum transition PP (discharge–12 weeks) Discharge education, monitoring, follow-up SMFM Special Statement: PP discharge checklist for women with hypertensive disorders (2020) (Gibson and Hameed, 2020)
  • Standardized discharge education on warning symptoms and support for home BP monitoring
  • Arranging a problem-focused PP visit within 1–3 weeks for women with hypertensive disorders
  • Counseling on recurrence risk, use of low-dose aspirin to reduce recurrence, and long-term cardiovascular risk with risk-modification strategies
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Topic Life stage Type Issuing body/document (year) Key recommendations (concise summary)a
Suspected preterm preeclampsia PN Diagnosis (adjunct testing) NICE diagnostics guidance: PLGF-based testing for suspected preterm preeclampsia (HTG630) (2022) (NICE, 2022)
  • NICE-approved PLGF-based tests and standard clinical assessment to rule in/out suspected preterm preeclampsia and guide care decisions
Antihypertensive medication safety (pregnancy) Prepregnancy–PN Medication AHA/ACC and partner societies: High BP pressure in adults guideline (Jones et al., 2025)
  • Methyldopa, nifedipine, or labetalol for HTN during pregnancy (COR I; LOE C-LD)
  • Not ACE inhibitors, ARBs, or direct renin inhibitors during pregnancy (COR III: Harm; LOE C-LD)
Hypertension in pregnancy (treatment thresholds and medication safety) Prepregnancy–PP Medication; management targets AHA/ACC and partner societies: High BP in adults guideline (Jones et al., 2025)
  • Labetalol or extended-release nifedipine as preferred drugs during pregnancy to minimize fetal risk (COR I; LOE A)
  • Counseling on low-dose aspirin (81 mg/day) to reduce the risk of preeclampsia and related sequelae (COR I; LOE B-R)
  • Treatment of severe-range BP (SBP ≥160 or DBP ≥110 mmHg, confirmed within 15 minutes) within 30–60 minutes to <160/<110 mmHg (COR I; LOE B-R)
  • Treatment of chronic HTN, including mild-range disease, to achieve BP <140/90 mmHg to reduce maternal and perinatal morbidity and mortality (COR I; LOE B-R)
  • Avoidance of fetotoxic drugs (e.g., atenolol, ACE inhibitors, ARBs, direct renin inhibitors, nitroprusside, MRAs) (COR III: Harm; LOE C-LD)
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Diabetes in pregnancy Prepregnancy–PP Counseling, screening/assessment, management NICE guideline: Diabetes in pregnancy (NG3) (updated 2020) (NICE, 2020)
  • Preconception counseling and pregnancy planning for women with diabetes, including counseling on diet, weight, exercise, and maternal and fetal risks
  • Diagnosis and management of GDM, including self-monitoring of blood glucose, lifestyle intervention, and stepwise escalation to pharmacologic therapy when glycemic targets are not met
  • PN care for women with diabetes, including ongoing glucose testing, counseling on future diabetes risk, and guidance on medication use during breastfeeding
Preexisting diabetes and pregnancy Prepregnancy–PP Preconception counseling, monitoring/technology, treatment, PP endocrine care Endocrine Society and European Society of Endocrinology: Preexisting Diabetes and Pregnancy (Wyckoff et al., 2025)
  • Screening question about pregnancy intention at routine reproductive, diabetes, or primary care visits (2 | ⊕OOO)
  • Contraception recommended if pregnancy is not desired (2 | ⊕⊕OO)
  • For TDM, discontinuance of GLP-1 receptor agonists before pregnancy rather than during early pregnancy (2 | ⊕OOO)
  • During pregnancy, use either CGM or SMBG; consider hybrid closed-loop pump systems for TDM (2 | ⊕OOO)
  • PP, diabetes management and endocrine follow-up in addition to usual obstetric care (2 | ⊕OOO)
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Topic Life stage Type Issuing body/document (year) Key recommendations (concise summary)a
Diabetes in pregnancy Prepregnancy–PP Counseling, monitoring, treatment, PP screening ADA Standards of Care: Management of Diabetes in Pregnancy (2024–2026) (ADA Professional Practice Committee for Diabetes, 2026)
  • Preconception counseling (starting at puberty) for all females with diabetes; incorporate into routine diabetes care (A)
  • Discussion of family planning and prescription of effective contraception until glycemic control is optimized (A)
  • Pregnancy-specific glucose targets (fasting <95 mg/dL; 1-hour postprandial <140 mg/dL; 2-hour postprandial <120 mg/dL) and recommend blood glucose monitoring to reach targets (B)
  • CGM for pregnant women with TDM (A)
  • GDM: lifestyle behavior change essential; insulin if needed to achieve glycemic goals (A)
  • PP after GDM: screen at 4–12 weeks with a 75-g oral glucose tolerance test; lifelong screening every 1–3 years (B)
Pregnancy-associated stroke prevention PN & early PP (≤6 weeks) and life course Management, risk factor evaluation AHA/American Stroke Association Guideline: Primary Prevention of Stroke (Bushnell et al., 2024)
  • In pregnant or early PP (within 6 weeks of delivery) patients with severe HTN, BP-lowering treatment to a target <160/110 mmHg as soon as possible to reduce the risk of fatal maternal intracranial hemorrhage (Class 1)
  • In patients with HDPs (including chronic HTN), treatment with medication to a goal BP <140/90 mmHg reasonable to reduce the risk of pregnancy-associated stroke (Class 2a)
  • Screening for a history of APOs (including HDPs, PTB, GDM, and placental disorders), followed by evaluation and management of vascular risk factors, to reduce the risk of stroke (Class 1)
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Chronic coronary disease and pregnancy Prepregnancy–PP Risk stratification, team-based care, medication AHA/ACC/American College of Clinical Pharmacy/American Society for Preventive Cardiology/National Lipid Association/Preventive Cardiovascular Nurses Association Guideline: Chronic Coronary Disease (Virani et al., 2023)
  • Assessment of risk for maternal cardiovascular events and fetal complications and discussion of cardiovascular and obstetrical care planning during preconception counseling, pregnancy, and PP (COR I; LOE C-LD)
  • Referral for females contemplating pregnancy to a high-risk obstetrician and a cardiologist for counseling before and during pregnancy (COR I; LOE C-LD)
  • A multidisciplinary cardio-obstetrics team approach reasonable for females contemplating pregnancy (COR IIa; LOE C-LD)
  • ACE inhibitors, ARBs, ARNIs, and MRAs avoided in pregnant females with chronic coronary disease because of fetal harm (COR III: Harm; LOE C-LD)
  • Continuation of statin therapy considered in select females who are pregnant or contemplating pregnancy (COR IIb; LOE C-LD)
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Topic Life stage Type Issuing body/document (year) Key recommendations (concise summary)a
Ventricular arrhythmias & sudden cardiac death prevention PN–PP Medication, acute management, procedures AHA/ACC/Heart Rhythm Society Guideline: Ventricular Arrhythmias & sudden cardiac death prevention (Al-Khatib et al., 2018)
  • Continuation beta blocker therapy in long QT syndrome during pregnancy and throughout the PP period (including in women who are breastfeeding) (COR I; LOE B-NR)
  • In the pregnant patient with sustained ventricular arrhythmias, electrical cardioversion safe and effective and should be used with standard electrode configuration (COR I; LOE C-EO)
  • In pregnant women needing an ICD or ventricular tachycardia ablation, reasonable to undergo these procedures during pregnancy, preferably after the first trimester (COR IIa; LOE B-NR)
  • In pregnant women at elevated risk for sudden cardiac death in whom ICD implantation is deferred, a wearable cardioverter-defibrillator may be a temporary risk-mitigation strategy (COR IIb; LOE C-LD)
Heart failure/cardiomyopathy in pregnancy Prepregnancy–PP Counseling, medication management AHA/ACC/Heart Failure Society of America Guideline: Heart Failure (Heidenreich et al., 2022)
  • Patient-centered counseling regarding contraception and the risks of cardiovascular deterioration during pregnancy in women with a history of HF or cardiomyopathy (including previous peripartum cardiomyopathy) (COR I; LOE C-LD)
  • In women with acute HF caused by peripartum cardiomyopathy and left ventricular ejection fraction <30%, anticoagulation possibly reasonable at diagnosis until 6–8 weeks PP, despite uncertain efficacy and safety (COR IIb; LOE C-LD)
  • In women with HF or cardiomyopathy who are pregnant or planning pregnancy, ACE inhibitors, ARBs, ARNIs, MRAs, SGLT2 inhibitors, ivabradine, and vericiguat should not be administered because of significant risks of fetal harm (COR III: Harm; LOE C-LD)
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Adult congenital heart disease and pregnancy Prepregnancy–PN Risk assessment, counseling, care planning AHA/ACC Guideline: ACHD (Stout et al., 2019)
  • Women with CHD given prepregnancy counseling with input from an ACHD cardiologist to determine maternal cardiac, obstetrical, and fetal risks and potential long-term risks to the mother (COR I; LOE C-LD)
  • An individualized plan of care that addresses expectations and contingencies developed for and with women with CHD who are or may become pregnant and shared with them and all caregivers (COR I; LOE C-LD)
  • Women with CHD receiving chronic anticoagulation counseled, ideally before pregnancy, on the risks and benefits of specific anticoagulants during pregnancy (COR I; LOE B-NR)
  • Women with ACHD AP classification IB-D, IIA-D, and IIIA-D managed collaboratively during pregnancy by cardiologists, obstetricians, and anesthesiologists experienced in ACHD (COR I; LOE B-NR)
  • Women with cardiovascular conditions classified as mWHO maternal cardiovascular risk class IV—including pulmonary arterial HTN, Eisenmenger syndrome, severe systemic ventricular dysfunction, severe left-sided obstructive lesions, and/or ACHD AP classification III/IV—receive urgent, patient-centered counseling regarding the extremely high risk of maternal morbidity and mortality associated with pregnancy, with discussion of medically indicated pregnancy avoidance and, when pregnancy occurs, medically necessary pregnancy termination as a standard component of evidence-based care, using shared decision-making (COR I; LOE C-EO)
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Topic Life stage Type Issuing body/document (year) Key recommendations (concise summary)a
Acute kidney injury/chronic kidney disease in pregnancy PN–PP Management, monitoring, care coordination NICE guideline: Acute kidney injury and chronic kidney disease (NG121) (NICE, 2019)
  • Multidisciplinary risk assessment for pregnant women with kidney disease, including involvement of renal specialists, to identify and manage risk of acute kidney injury
  • Careful intrapartum fluid balance monitoring and PP follow-up of renal function in women with kidney disease and avoidance of nephrotoxic medications (e.g., NSAIDs, not including aspirin) where possible
Heart disease in pregnancy (risk assessment and care model) Prepregnancy–PP Risk assessment, multidisciplinary care NICE guideline: Intrapartum care for women with existing medical conditions or obstetric complications and their babies (2019) (NICE, 2019)
  • Risk assessment follows multidisciplinary team principles and includes cardiology expertise in pregnancy heart disease
  • The mWHO classification used and risk reassessed regularly during pregnancy and intrapartum
Heart disease in pregnancy (screening, diagnosis, management) Prepregnancy–PP Screening/assessment, diagnosis, management ACOG Practice Bulletin No. 212: Pregnancy and Heart Disease (2019) (ACOG, 2019b)
  • Early antepartum and PP identification and modification of cardiovascular risk factors and management of preexisting or new-onset heart disease
  • Multidisciplinary pregnancy heart team care for moderate- and high-risk patients, with emphasis on PP and interpregnancy planning
Cardio-obstetrics team-based care Prepregnancy/PN/PP Care model/management framework AHA Scientific Statement: Cardiovascular Considerations in Caring for Pregnant Patients (2020) (Mehta et al., 2020)
  • Early involvement of a multidisciplinary cardio-obstetrics (pregnancy heart team) for pregnant patients with CVD to reduce maternal morbidity and mortality
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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CVD and pregnancy (comprehensive international guideline) Prepregnancy/PN/PP Risk stratification, management, PP follow-up European Society of Cardiology: 2025 Guidelines for management of CVD and pregnancy (De Backer et al., 2025)
  • Cardiovascular risk assessment in all women with CVD of childbearing age using the mWHO 2.0 classification (Class I; Level C)
  • Women with CVD with mWHO class II–III and above evaluated and managed by a pregnancy heart team from prepregnancy throughout pregnancy and the PP period (Class I; Level C)
  • In women with CVD with mWHO class IV, discussion by the pregnancy heart team regarding high risk and shared decision-making about pregnancy termination (Class I; Level C)
Life Course Cardiovascular Risk, Postpartum Transition, and Interpregnancy Care
Prepregnancy cardiovascular health optimization Prepregnancy/interpregnancy Risk assessment and optimization framework AHA Scientific Statement: Optimizing Prepregnancy Cardiovascular Health (2023) (Khan et al., 2023)
  • Life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health
  • Recognition of prepregnancy and interpregnancy periods as critical windows to improve pregnancy outcomes and long-term cardiovascular health
Adverse pregnancy outcomes and later CVD risk PP → life course Risk identification and prevention framework AHA Scientific Statement: APOs and CVD Risk (2021) (Parikh et al., 2021)
  • Recognition of APOs (including HDPs, PTB, and GDM) as markers of increased lifetime cardiovascular risk factors and CVD
  • Incorporation of pregnancy history, including APOs, into cardiovascular risk assessment and prevention strategies across the life course
Reducing CVD risk after adverse pregnancy outcomes PP (fourth trimester and beyond) Clinical, health system, community interventions AHA Scientific Statement: Opportunities in the PP Period to Reduce CVD Risk After APOs (2024) (Lewey et al., 2024)
  • PP and interpregnancy preventive strategies—including BP management and lifestyle interventions—to optimize cardiovascular health after APOs
  • Multilevel interventions at the clinical, health system, and community levels to reduce CVD risk after APOs
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Topic Life stage Type Issuing body/document (year) Key recommendations (concise summary)a
Postpartum care model PP (0–12 weeks) Care delivery and follow-up schedule ACOG Committee Opinion No. 736: Optimizing PP Care (2018; endorsed by SMFM) (ACOG, 2018)
  • PP care as an ongoing process tailored to individual needs rather than a single PP visit
  • Contact with an obstetric care provider within the first 3 weeks PP, followed by ongoing care as needed, with a comprehensive PP visit no later than 12 weeks after birth
Interpregnancy care Interpregnancy/life course Care framework ACOG/SMFM Obstetric Care Consensus No. 8: Interpregnancy Care (2019) (ACOG and SMFM, 2019)
  • Definition of interpregnancy care as a continuum for overall health and wellness, with the goal of maximizing health between pregnancies and across the life course
  • Optimization of chronic conditions and modifiable risk factors and preventive counseling to improve health before future pregnancies and long-term maternal outcomes
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Other Conditions and Lifestyle Factors Relevant to Cardiovascular Disease Risk
Obstructive sleep apnea in pregnancy Pregnancy–PP Screening, diagnosis, treatment Society of Anesthesia and Sleep Medicine + Society for Obstetric Anesthesia and Perinatology (endorsed by ACOG/SMFM): OSA in pregnancy guideline (2023) (Dominguez et al., 2023)
  • Do not recommend universal screening of all pregnant people for OSA (Class III: no benefit; LOE C-EO)
  • Suggested screening pregnant people with obesity (BMI ≥30) for OSA (Class IIa; LOE C-EO)
  • Suggested OSA screening for pregnant people with HDPs or diabetes in the index or prior pregnancy (Class IIb; LOE C-EO)
  • Do not recommend Berlin or STOP-BANG questionnaires as screening tools in pregnancy (Class III: no benefit; LOE B-NR)
  • Home sleep apnea testing possible reasonable diagnostic tool (Class IIb; LOE B-NR)
  • Do not recommend overnight pulse oximetry as a diagnostic tool for OSA in pregnancy (Class III: no benefit; LOE C-EO)
  • CPAP therapy to treat OSA symptoms/normalization of objective measures; counseling that effects on pregnancy-specific outcomes unknown (Class IIb; LOE B-NR/C-LD)
  • PP repeat diagnostic testing possible (Class IIb; LOE C-LD)
Mental health conditions during pregnancy and postpartum PN–PP Screening/diagnosis; treatment/management ACOG: Mental Health Conditions During Pregnancy and PP (2023) (ACOG, 2023a,b)
  • Screening, diagnosis, and management of perinatal mental health conditions during pregnancy and the PP period
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Topic Life stage Type Issuing body/document (year) Key recommendations (concise summary)a
Postpartum depression (medication) PP (≤12 months) Medication ACOG Clinical Practice Update (endorsed by SMFM): Zuranolone and Brexanolone for PP depression (2026) (Zuranolone and brexanolone for the treatment of postpartum depression, 2026)
  • Consideration of Zuranolone for depression with onset in the third trimester or within 4 weeks PP, with shared decision making that balances benefits against risks (e.g., sedation, suicidality warning, and limited long-term efficacy data)
General Maternity Care Delivery Guidance (Included for Context and Implementation)
Tailored prenatal care delivery PN Care delivery ACOG Clinical Consensus: Tailored Prenatal Care Delivery (2025; endorsed by multiple orgs including SMFM) (ACOG, 2025)
  • Early comprehensive PN needs assessment—including medical, social, and structural drivers of health—with shared decision-making and referral or coordination to address unmet social needs
  • Tailoring of PN visit frequency and modality, including telemedicine, to ensure completion of guideline-based recommended services
Intrapartum care (service organization) Intrapartum Service organization NICE guideline: Intrapartum care (term births) (NG235) (updated 2025) (NICE, 2025)
  • Ensured access to all available birth settings and timely transfer pathways to obstetric units when needed, with robust multidisciplinary governance structures across settings
Routine antenatal care (booking and clinical care) PN Assessment; health behavior risk inquiry NICE guideline: Antenatal care (NG201) (2021) (NICE, 2021a)
  • At the first antenatal (booking) appointment, comprehensive assessment of medical, obstetric, and family history, including inquiry about mental health, current and recent medications, and health behaviors (diet, PA, smoking, alcohol, and drug use)
Postnatal care (organization and delivery) PP Care delivery NICE guideline: PN care (NG194) (2021) (NICE, 2021b)
  • Tailoring of PN information and care delivery to individual needs and preferences, supporting shared decision making and equitable access to services
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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NOTES: a Evidence/strength ratings are shown in parentheses in the Key Recommendations column when provided by the issuing organization; not all guidance documents use an explicit grading system. Ratings reflect each organization’s own framework and are not intended for direct cross-comparison. ACC/AHA/ASA and partner societies: Class of Recommendation (COR) and Level of Evidence (LOE) are shown as (COR X; LOE Y) when both are reported. COR may be displayed as 1/2a/2b/3 (or I/IIa/IIb/III). In general: 1 (I) = recommended; 2a (IIa) = reasonable; 2b (IIb) = may be considered; 3 (III): No Benefit = not recommended (no benefit); 3 (III): Harm = potentially harmful. LOE: A = high-quality evidence; B-R = moderate-quality randomized; B-NR = moderate-quality nonrandomized; C-LD = limited data; C-EO = expert opinion. (Some publicly available slide sets report COR/Class without LOE.) European Society of Cardiology: Class of Recommendation (I, IIa, IIb, III) and Level of Evidence (A, B, C) are shown as (Class X; Level Y). Endocrine Society: Grade is shown as (1 or 2; ⊕ to ⊕⊕⊕⊕), where 1 = strong recommendation and 2 = conditional recommendation; ⊕⊕⊕⊕ = high, ⊕⊕⊕ = moderate, ⊕⊕ = low, and ⊕ = very low quality of evidence. ADA: Grades are shown as (A/B/C/E): A = clear evidence from well-conducted, generalizable studies; B = supportive evidence from well-conducted cohort or case-control studies; C = supportive evidence from poorly controlled or uncontrolled studies; E = expert consensus/clinical experience. ACC = American College of Cardiology; ACE = angiotensin-converting enzyme; ACHD = adult congenital heart disease; ACOG = American College of Obstetricians and Gynecologists; ADA = American Diabetes Association; AHA = American Heart Association; APO = adverse pregnancy outcome; ARB = angiotensin receptor blocker; ARNi = angiotensin receptor-neprilysin inhibitor; BP = blood pressure; CGM = continuous glucose monitoring; CHD = congenital heart disease; CPAP = continuous positive airway pressure; CVD = cardiovascular disease; DBP = diastolic blood pressure; GDM = gestational diabetes mellitus; GLP-1 = Glucagon-like peptide-1; HDP = hypertensive disorder of pregnancy; HF = heart failure; HTN = hypertension; ICD = implantable cardioverter-defibrillator; ISSHP = International Society for the Study of Hypertension in Pregnancy; MRA = mineralocorticoid receptor antagonist; mWHO = modified World Health Organization pregnancy risk classification; NICE = National Institute for Health and Care Excellence; NSAID = nonsteroidal anti-inflammatory; OSA = obstructive sleep apnea; PA = physical activity; PLGF = placental growth factor; PN = prenatal; PP = postpartum; PTB = preterm birth; SBP = systolic blood pressure; SGLT2i = sodium-glucose cotransporter-2 inhibitor; SMBG = self-monitoring of blood glucose; SMFM = Society for Maternal-Fetal Medicine; STOP-BANG = snoring, tired, observed, pressure, body mass index, age, neck size, and gender; TDM = type 2 diabetes mellitus; USPSTF = U.S. Preventive Services Task Force.

SOURCES: Obstetric care consensus no. 8: Interpregnancy care, 2019; Zuranolone and brexanolone for the treatment of postpartum depression, 2026; ACOG, 2018, 2019a,b, 2020, 2021, 2022, 2023a,b, 2025; ACOG and SMFM, 2019a,b; ADA Professional Practice Committee for Diabetes, 2026; Al-Khatib et al., 2018; Bushnell et al., 2024; De Backer et al., 2025; Dominguez et al., 2023; Gibson and Hameed, 2020; Heidenreich et al., 2022; Jones et al., 2025; Khan et al., 2023; Lewey et al., 2024; Magee et al., 2022; Mehta et al., 2020; NICE, 2019, 2020, 2021a,b, 2022, 2023, 2025; Parikh et al., 2021; Society for Maternal-Fetal Medicine, 2022; Stout et al., 2019; Virani et al., 2023; Wyckoff et al., 2025.

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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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REFERENCES

ACOG (American College of Obstetricians and Gynecologists). 2018. Committee Opinion 736: Optimizing Postpartum Care. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care (accessed December 26, 2025).

ACOG. 2019a. ACOG practice bulletin no. 203: Chronic hypertension in pregnancy. Obstetrics and Gynecology 133(1):e26–e50. 10.1097/AOG.0000000000003020.

ACOG. 2019b. ACOG practice bulletin no. 212: Pregnancy and heart disease. Obstetrics & Gynecology 133(5):e320–e356. https://doi.org/10.1097/aog.0000000000003243.

ACOG. 2020. ACOG practice bulletin no. 222: Gestational hypertension and preeclampsia. Obstetrics & Gynecology 135(6):e237–e260. https://doi.org/10.1097/AOG.0000000000003891.

ACOG. 2021. Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality (accessed January 2, 2026).

ACOG. 2022. Clinical Guidance for the Integration of the Findings of the Chronic Hypertension and Pregnancy (CHAP) Study. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/04/clinical-guidance-for-the-integration-of-the-findings-of-the-chronic-hypertension-and-pregnancy-chap-study (accessed December 26, 2025).

ACOG. 2023a. Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG clinical practice guideline no. 4. Obstetrics & Gynecology 141(6):1232–1261. https://doi.org/10.1097/aog.0000000000005200.

ACOG. 2023b. Treatment and management of mental health conditions during pregnancy and postpartum: ACOG clinical practice guideline no. 5. Obstetrics & Gynecology 141(6):1262–1288. https://doi.org/10.1097/aog.0000000000005202.

ACOG. 2025. Tailored prenatal care delivery for pregnant individuals: ACOG clinical consensus no. 8. Obstetrics & Gynecology 145(5):565–577. https://doi.org/10.1097/AOG.0000000000005889.

ACOG and SMFM (Society for Maternal-Fetal Medicine). 2019a. Obstetric care consensus no. 8: Interpregnancy care. Obstetrics & Gynecology 133(1):e51–e72. https://doi.org/10.1097/aog.0000000000003025.

ACOG and SMFM. 2019b. Interpregnancy care. American Journal of Obstetrics and Gynecology 220(1):B2–B18. https://doi.org/10.1016/j.ajog.2018.11.1098.

ADA (American Diabetes Association) Professional Practice Committee for Diabetes. 2026. 15. Management of diabetes in pregnancy: Standards of care in diabetes—2026. Diabetes Care 49(1):S321-S338. https://doi.org/10.2337/dc26-S015.

Al-Khatib, S. M., W. G. Stevenson, M. J. Ackerman, W. J. Bryant, D. J. Callans, A. B. Curtis, B. J. Deal, T. Dickfeld, M. E. Field, G. C. Fonarow, A. M. Gillis, C. B. Granger, S. C. Hammill, M. A. Hlatky, J. A. Joglar, G. N. Kay, D. D. Matlock, R. J. Myerburg, and R. L. Page. 2018. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation 138(13):e272–e391. https://doi.org/10.1161/CIR.0000000000000549.

Bushnell, C., W. N. Kernan, A. Z. Sharrief, S. Chaturvedi, J. W. Cole, W. K. Cornwell, C. Cosby-Gaither, S. Doyle, L. B. Goldstein, O. Lennon, D. A. Levine, M. Love, E. Miller, M. Nguyen-Huynh, J. Rasmussen-Winkler, K. M. Rexrode, N. Rosendale, S. Sarma, D. Shimbo, A. N. Simpkins, E. S. Spatz, L. R. Sun, V. Tangpricha, D. Turnage, G. Velazquez, and P. K. Whelton. 2024. 2024 guideline for the primary prevention of stroke: A guideline from the American Heart Association/American Stroke Association. Stroke 55(12):e344–e424. https://doi.org/10.1161/STR.0000000000000475.

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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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De Backer, J., K. H. Haugaa, N. E. Hasselberg, M. de Hosson, M. Brida, S. Castelletti, M. Cauldwell, E. Cerbai, L. Crotti, N. M. S. de Groot, M.-E. Estensen, E. S. Goossens, B. Haring, D. Kurpas, C. M. McEniery, S. A. E. Peters, A. Rakisheva, A. Sambola, O. Schlager, F. S. Schoenhoff, T. Simoncini, F. Steinbach, I. Sudano, L. Swan, A. M. Valente, and ESC Scientific Document Group. 2025. 2025 ESC guidelines for the management of cardiovascular disease and pregnancy: Developed by the Task Force on the Management of Cardiovascular Disease and Pregnancy of the European Society of Cardiology (ESC) endorsed by the European Society of Gynecology (ESG). European Heart Journal 46(43):4462–4568. https://doi.org/10.1093/eurheartj/ehaf193.

Dominguez, J. E., S. Cantrell, A. S. Habib, B. Izci-Balserak, E. Lockhart, J. M. Louis, A. Miskovic, J. W. Nadler, M. Nagappa, L. M. O’Brien, C. Won, and G. Bourjeily. 2023. Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology consensus guideline on the screening, diagnosis, and treatment of obstructive sleep apnea in pregnancy. Obstetrics & Gynecology 142(2):403–423. https://doi.org/10.1097/aog.0000000000005261.

Gibson, K. S., and A. B. Hameed. 2020. Society for Maternal-Fetal Medicine special statement: Checklist for postpartum discharge of women with hypertensive disorders. American Journal of Obstetrics and Gynecology 223(4):B18–B21. https://doi.org/10.1016/j.ajog.2020.07.009.

Heidenreich, P. A., B. Bozkurt, D. Aguilar, L. A. Allen, J. J. Byun, M. M. Colvin, A. Deswal, M. H. Drazner, S. M. Dunlay, L. R. Evers, J. C. Fang, S. E. Fedson, G. C. Fonarow, S. S. Hayek, A. F. Hernandez, P. Khazanie, M. M. Kittleson, C. S. Lee, M. S. Link, C. A. Milano, L. C. Nnacheta, A. T. Sandhu, L. W. Stevenson, O. Vardeny, A. R. Vest, C. W. Yancy, J. A. Beckman, P. T. O’Gara, S. M. Al-Khatib, A. L. Armbruster, K. K. Birtcher, J. E. Cigarroa, L. de las Fuentes, A. Deswal, D. L. Dixon, L. A. Fleisher, F. Gentile, Z. D. Goldberger, B. Gorenek, N. Haynes, A. F. Hernandez, M. A. Hlatky, J. A. Joglar, W. S. Jones, J. E. Marine, D. B. Mark, D. Mukherjee, L. P. Palaniappan, M. R. Piano, T. Rab, E. S. Spatz, J. E. Tamis-Holland, D. N. Wijeysundera, and Y. J. Woo. 2022. 2022 ACC/AHA/HFSA guideline for the management of heart failure. Journal of Cardiac Failure 28(5):e1–e167. https://doi.org/10.1016/j.cardfail.2022.02.010.

Jones, D. W., K. C. Ferdinand, S. J. Taler, H. M. Johnson, D. Shimbo, M. Abdalla, M. M. Altieri, N. Bansal, N. A. Bello, A. P. Bress, J. Carter, J. B. Cohen, K. J. Collins, Y. Commodore-Mensah, L. L. Davis, B. Egan, S. S. Khan, D. M. Lloyd-Jones, B. M. Melnyk, E. A. Mistry, M. O. Ogunniyi, S. L. Schott, S. C. Smith, A. W. Talbot, W. Vongpatanasin, K. E. Watson, P. K. Whelton, and J. D. Williamson. 2025. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 152(11):e114–e218. https://doi.org/10.1161/CIR.0000000000001356.

Khan, S. S., L. C. Brewer, M. M. Canobbio, M. J. Cipolla, W. A. Grobman, J. Lewey, E. D. Michos, E. C. Miller, A. M. Perak, G. S. Wei, H. Gooding. 2023. Optimizing prepregnancy cardiovascular health to improve outcomes in pregnant and postpartum individuals and offspring: A scientific statement from the American Heart Association. Circulation 147(7):e76–e91. https://doi.org/10.1161/CIR.0000000000001124.

Lewey, J., T. M. Beckie, H. L. Brown, S. D. Brown, V. D. Garovic, S. S. Khan, E. C. Miller, G. Sharma, and L. S. Mehta. 2024. Opportunities in the postpartum period to reduce cardiovascular disease risk after adverse pregnancy outcomes: A scientific statement from the American Heart Association. Circulation 149(7):e330–e346. https://doi.org/10.1161/CIR.0000000000001212.

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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Magee, L. A., M. A. Brown, D. R. Hall, S. Gupte, A. Hennessy, S. A. Karumanchi, L. C. Kenny, F. McCarthy, J. Myers, L. C. Poon, S. Rana, S. Saito, A. C. Staff, E. Tsigas, and P. von Dadelszen. 2022. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension 27:148–169. https://doi.org/10.1016/j.preghy.2021.09.008.

Mehta, L. S., C. A. Warnes, E. Bradley, T. Burton, K. Economy, R. Mehran, B. Safdar, G. Sharma, M. Wood, A. M. Valente, and A. S. Volgman. 2020. Cardiovascular considerations in caring for pregnant patients: A scientific statement from the American Heart Association. Circulation 141(23):e884–e903. https://doi.org/10.1161/CIR.0000000000000772.

NICE (National Institute for Health and Care Excellence). 2019. Intrapartum Care for Women with Existing Medical Conditions or Obstetric Complications and Their Babies. https://www.nice.org.uk/guidance/ng121/resources/intrapartum-care-for-women-with-existing-medical-conditions-or-obstetric-complications-and-their-babies-pdf-66141653845957 (accessed January 5, 2026).

NICE. 2020. Diabetes in Pregnancy: Management from Preconception to the Postnatal Period. https://www.nice.org.uk/guidance/ng3/resources/diabetes-in-pregnancy-management-from-preconception-to-the-postnatal-period-pdf-51038446021 (accessed January 2, 2026).

NICE. 2021a. Antenatal Care. https://www.nice.org.uk/guidance/ng201/resources/antenatal-care-pdf-66143709695941 (accessed January 2, 2026).

NICE. 2021b. Postnatal Care. https://www.nice.org.uk/guidance/ng194 (accessed January 13, 2026).

NICE. 2022. PLGF-Based Testing to Help Diagnose Suspected Preterm Pre-Eclampsia. https://www.nice.org.uk/guidance/htg630/resources/plgfbased-testing-to-help-diagnose-suspected-preterm-preeclampsia-pdf-1809598519352005 (accessed January 2, 2026).

NICE. 2023. Hypertension in Pregnancy: Diagnosis and Management. https://www.nice.org.uk/guidance/ng133/resources/hypertension-in-pregnancydiagnosis-and-management-pdf-66141717671365 (accessed December 31, 2025).

NICE. 2024. Acute Kidney Injury: Prevention, Detection and Management. https://www.nice.org.uk/guidance/ng148/resources/acute-kidney-injury-prevention-detection-and-management-pdf-66141786535621 (accessed January 2, 2026).

NICE. 2025. Intrapartum Care. https://www.nice.org.uk/guidance/ng235/resources/intrapartum-care-pdf-66143897812933 (accessed January 2, 2026).

Parikh, N. I., J. M. Gonzalez, C. A. M. Anderson, S. E. Judd, K. M. Rexrode, M. A. Hlatky, E. P. Gunderson, J. J. Stuart, D. Vaidya, American Heart Association, Council on Epidemiology and Prevention, Council on Arteriosclerosis Thrombosis and Vascular Biology, Council on Cardiovascular and Stroke Nursing, and Stroke Council. 2021. Adverse pregnancy outcomes and cardiovascular disease risk: Unique opportunities for cardiovascular disease prevention in women: A scientific statement from the American Heart Association. Circulation 143(18):e902–e916. https://doi.org/10.1161/CIR.0000000000000961.

Society for Maternal-Fetal Medicine. 2022. Society for Maternal-Fetal Medicine statement: Antihypertensive therapy for mild chronic hypertension in pregnancy—the Chronic Hypertension and Pregnancy trial. American Journal of Obstetrics and Gynecology 227(2):B24–B27. https://doi.org/10.1016/j.ajog.2022.04.011.

Stout, K. K., C. J. Daniels, J. A. Aboulhosn, B. Bozkurt, C. S. Broberg, J. M. Colman, S. R. Crumb, J. A. Dearani, S. Fuller, M. Gurvitz, P. Khairy, M. J. Landzberg, A. Saidi, A. M. Valente, and G. F. Van Hare. 2019. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 139(14):e698–e800. https://doi.org/10.1161/CIR.0000000000000603.

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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Virani, S. S., L. K. Newby, S. V. Arnold, V. Bittner, L. C. Brewer, S. H. Demeter, D. L. Dixon, W. F. Fearon, B. Hess, H. M. Johnson, D. S. Kazi, D. Kolte, D. J. Kumbhani, J. LoFaso, D. Mahtta, D. B. Mark, M. Minissian, A. M. Navar, A. R. Patel, M. R. Piano, F. Rodriguez, A. W. Talbot, V. R. Taqueti, R. J. Thomas, S. van Diepen, B. Wiggins, and M. S. Williams. 2023. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines. Circulation 148(9):e9–e119. https://doi.org/10.1161/CIR.0000000000001168.

Wyckoff, J. A., A. Lapolla, B. D. Asias-Dinh, L. A. Barbour, F. M. Brown, P. M. Catalano, R. Corcoy, G. C. Di Renzo, N. Drobycki, A. Kautzky-Willer, M. H. Murad, M. Stephenson-Gray, A. G. Tabák, E. Weatherup, C. Zera, and N. Singh-Ospina. 2025. Preexisting diabetes and pregnancy: An Endocrine Society and European Society of Endocrinology joint clinical practice guideline. European Journal of Endocrinology 193(1):G1–G48. https://doi.org/10.1093/ejendo/lvaf116.

Zuranolone and brexanolone for the treatment of postpartum depression. 2026. Obstetrics & Gynecology 147(1):e24–e28. https://doi.org/10.1097/aog.0000000000006093.

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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Suggested Citation: "Appendix B: Clinical Service Guidance from Professional Societies Related to Cardiovascular Disease and Pregnancy." National Academies of Sciences, Engineering, and Medicine. 2026. Protecting Maternal Heart Health: Prevention and Care Before, During, and After Pregnancy. Washington, DC: The National Academies Press. doi: 10.17226/29425.
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Next Chapter: Appendix C: Search Strategy for Evidence Reviews
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