Pregnancy-Associated Spontaneous Coronary Artery Dissection as a Precision Cardio-Obstetric Disorder: A Systematic Review Integrating Vascular Biology, Imaging Strategy, Postpartum Recurrence Counseling, and Maternal Mental Health

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) has shifted, over the last decade, from a perceived clinical curiosity to a leading cause of myocardial infarction in young pregnant and postpartum women. Despite this recognition, care remains fragmented: cardiology-centric frameworks often overlook obstetric realities, while perinatal pathways underestimate vascular biology and long-term cardiovascular risk. We therefore undertook a systematic review to synthesize contemporary evidence on P-SCAD through a precision cardio-obstetric lens, explicitly integrating vascular mechanisms, diagnostic imaging strategies, acute and longitudinal management, recurrence counseling, and maternal mental health outcomes. Following PRISMA 2020 guidance, we systematically searched major biomedical databases for studies addressing pregnancy-associated SCAD, applying predefined inclusion criteria and structured risk-of-bias assessment. Thirty-six studies met eligibility, encompassing registry cohorts, case series, individual patient-data synthesis, and focused mechanistic reports. Rather than pursuing meta-analytic aggregation where heterogeneity was prohibitive, we employed thematic synthesis aligned to biological pathways, clinical timelines, and patient-centered outcomes. Across the literature, pregnancy-specific hemodynamic stressors, hormonal influences, and underlying arteriopathies converge to create a period of unique coronary vulnerability. Conservative management predominates and is often successful, yet decisions around imaging, intervention, delivery planning, and antithrombotic therapy remain nuanced and context-dependent. Importantly, recurrence risk appears low to moderate for most patients, but uncertainty persists, and the psychological sequelae—fear of exertion, postpartum depression, and post-traumatic stress—are consistently under-recognized. By reframing P-SCAD as a precision cardio-obstetric disorder rather than an isolated cardiac event, this review highlights critical gaps in evidence, proposes integrated clinical algorithms, and argues for longitudinal, multidisciplinary care models that treat maternal cardiovascular and mental health as inseparable outcomes.