Guideline-directed Medical Therapy in Pregnancy and Lactation: Navigating Evidence Gaps and Clinical Application

Highlights: Cardio-Obstetrics integrates multidisciplinary care to manage pregnant patients with systolic heart failure, a high-risk condition associated with significant pregnancy-related mortality. Most Guideline-directed therapies are contraindicated in pregnancy due to fetal teratogenicity, necessitating careful selection of safe alternatives for the management of HFrEF in pregnancy. There is a critical need for more research on the safety and efficacy of heart failure medications during pregnancy and lactation to optimize maternal and fetal outcomes.