Where are the Recommendations on Healthy Lifestyle and Cardiovascular Disease Prevention for Pregnant Women?

F rom the practical point of view, there is still a large knowledge gap relating to how to effectively prevent, diagnose, and treat cardiovascular risk factors and cardiovascular disease and its complications in pregnant women. In many countries, both cardiologists and obstetricians are still afraid to treat such cases owing to a lack of knowledge, data (in most of the available studies, pregnancy is one of the most important exclusion criteria), and practical guidelines. In consequence, most of the existing guidelines still base their recommendations on expert opinion and/or relatively small cohort studies of short duration and mainly focus on the treatment of existing diseases such as coronary heart disease, arrhythmias, thromboembolic diseases, aortic and valvular disease, congenital heart diseases, and/or cardiomyopathies or heart failure. Moreover, in most of the existing guidelines, especially in Europe, there is no information on the effective management of cardiovascular risk factors and effective methods of prevention of cardiovascular disease (CVD) during pregnancy. This is especially important now as there is an increasing trend towards more and more women becoming pregnant at an older age. In busy obstetrical centers, including the one I represent, it is now common to see pregnant women at the age of ≥45 years and even ≥50 years. Therefore, the analysis presented by Dr. Perak and colleagues on pregnant women <45 years does not, in fact, reflect the current age trends and therefore misses (probably because of a paucity of pregnant women aged >45 years in their study) the most challenging group of pregnant women with respect to the prevention and management of CVD. These pregnancies in the late reproductive years might be expected to be associated with an increasing prevalence of cardiovascular risk factors, especially diabetes mellitus, hypertension, and obesity. Because of this fact, as well as because of a general increase in unhealthy behaviors in the population (significant increase of underweight and obesity, low level of physical exercise, increase of smoking for some age ranges, especially in young women, and unhealthy diet— often with an inappropriate approach to weight loss), effective prevention of CVD by ameliorating cardiovascular risk factors is the most crucial current issue. It is critically important because aside from the treatment of gestational hypertension (occurring in as many as 7–10% of all pregnancies) and diabetes mellitus, there are no recommendations on healthy diet for pregnant women, no clear data on optimal physical activity (which should be individualized and fitted for the pregnancy trimester [T]), and there is a complete lack of knowledge on how to prevent and manage lipid disorders (the existing obstetrical guidelines do not even make any recommendations for lipid monitoring), which may be a significant risk factor for complications both for the mother (preeclampsia, stillbirth, recurrent pregnancy loss), and for the child (preterm delivery or intrauterine growth restriction).