Valvular Heart Diseases in Pregnancy: Current Insights and Recent Advances

Abstract Purpose of Review Valvular heart disease (VHD) in pregnancy remains an important cause of maternal and fetal morbidity worldwide. Risk is influenced by lesion type and severity, prosthetic valve status, associated aortopathy, and access to specialized cardio-obstetric care. This review summarizes current evidence on the epidemiology, risk stratification, lesion-specific management, anticoagulation challenges, and multidisciplinary care of VHD from preconception through the postpartum period. Recent Findings Recent evidence supports structured risk assessment using the modified World Health Organization (mWHO 2.0) classification, with adjunctive tools such as CARPREG II and selected valve-specific models in appropriate populations. Left-sided stenotic lesions, mechanical prosthetic valves, and significant aortopathy remain the highest-risk phenotypes, whereas chronic regurgitant lesions are often better tolerated but may still be associated with adverse outcomes when symptoms, ventricular dysfunction, or multivalve disease are present. Contemporary registries and cohort studies have refined estimates of maternal, fetal, and neonatal risk and have highlighted the importance of Pregnancy Heart Team pathways, serial imaging surveillance, careful peripartum planning, and selective use of transcatheter interventions. Summary Optimal outcomes in pregnant patients with VHD depend on early risk assessment, lesion-specific counselling, coordinated Cardio-Obstetric multidisciplinary care at an experienced center, and vigilant postpartum follow-up. Future priorities include safer anticoagulation strategies, improved lesion-specific risk prediction, standardized surveillance pathways, and stronger evidence to guide intervention and delivery planning.