Genotype-to-bedside Precision Perinatology for Inherited Cardiac Channelopathies: A Systematic Review and Evidence Map of Maternal–Fetal–Neonatal Risk across the Perinatal Continuum

Inherited cardiac channelopathies are increasingly identified in women of reproductive age through contemporary genetic testing, often well before clinical manifestations emerge. Pregnancy and the early postpartum period, however, introduce profound hormonal, autonomic, and hemodynamic changes that may reshape arrhythmic vulnerability in ways not captured by nonpregnant risk models. Despite this, perinatal evidence remains fragmented across cardiology, genetics, obstetrics, fetal cardiology, and neonatology, with limited synthesis across maternal, fetal, and neonatal stages. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review accompanied by evidence mapping to integrate available literature across this continuum, focusing on long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome, and related inherited arrhythmia syndromes. Major bibliographic databases and clinical registers were searched, records were independently screened, and eligibility was determined using predefined criteria emphasizing perinatal relevance. Forty-one studies met inclusion criteria. Given substantial clinical, genetic, and methodological heterogeneity, findings were synthesized narratively and organized by genotype, physiologic modifiers, and perinatal timing rather than pooled quantitatively. Across syndromes, the literature consistently suggests that arrhythmic risk is dynamic rather than static, with recurrent signals of heightened vulnerability during the early postpartum period. Several studies reported persistent fetal bradycardia or conduction abnormalities as in utero markers associated with inherited repolarization disorders, while neonatal electrocardiographic assessment in selected population was described as a means of early risk recognition. Rather than issuing management recommendations, this synthesis reframes inherited channelopathies in pregnancy as precision-perinatal conditions and maps where risk appears concentrated, where signals recur, and where uncertainty remains. These findings highlight opportunities for coordinated maternal–fetal–neonatal assessment while underscoring the need for prospective, pregnancy-focused studies to define decision-grade evidence.