Clinical Considerations in Management of Hypertrophic Cardiomyopathy in Pregnancy: JACC State-of-the-Art Review.

Abstract

Hypertrophic cardiomyopathy (HCM) in pregnancy presents unique hemodynamic and arrhythmic challenges despite generally low maternal mortality. This JACC State-of-the-Art Review synthesizes current evidence on preconception risk stratification, genetic counseling, antepartum surveillance, arrhythmia management, and delivery and postpartum care. Key considerations include assessing left ventricular outflow tract obstruction, systolic function, and arrhythmia burden and applying CARPREG II (Cardiac Disease in Pregnancy Study II)/modified World Health Organization classifications to guide monitoring intensity. Pregnancy is typically well tolerated in low-risk women, whereas severe obstruction or systolic dysfunction confers high maternal-fetal risk. Multidisciplinary pregnancy heart team management remains essential to optimize outcomes and support informed decision making across the reproductive continuum.