Abstract
Heart failure (HF) remains the leading cardiovascular cause of maternal morbidity and mortality worldwide. The 2025 ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy.1 represent a pivotal update, reframing pregnancy in women with HF from a high-risk contraindication towards a condition that, in selected cases, can be safely managed through structured, multidisciplinary care. Importantly, the document introduces not only refinements in antenatal management but also a paradigm shift toward post-pregnancy cardiovascular risk assessment and long-term surveillance, particularly following adverse pregnancy outcomes. This evolution is particularly relevant for women with pre-existing HF, cardiomyopathy, or peripartum cardiomyopathy (PPCM), where recent registry and trial data have begun to illuminate both progress and persistent uncertainty.2 A major novelty of the 2025 ESC Guidelines (Figure 1) is the formal integration of long-term cardiovascular care following pregnancy, especially after adverse pregnancy outcomes such as pre-eclampsia, gestational hypertension, or fetal growth restriction.1 From a public health perspective, this represents a substantial advance, as the guidelines now recommend structured cardiovascular risk assessment approximately 3 months postpartum, with implications for lifelong prevention strategies.