Review of the Assessment and Management of Aortopathy in Pregnancy and Peripartum

Purpose of Review Thoracic aortic disease is a notable contributor to maternal morbidity, in which nearly half of affected women are unaware of their diagnosis until acute complication occurs. To frame the discussion of recommendations and evidence specific to common types of thoracic aortic disease, this review compares the 2022 American College of Cardiology (ACC)/American Heart Association (AHA) and 2025 European Society of Cardiology (ESC) guidelines for managing aortopathy across different periods of pregnancy. Recent Findings Both guidelines emphasize preconception counseling, multidisciplinary care, imaging surveillance, and consideration of prophylactic surgery, which is determined by degree of risk based on pathology and aortic measurement. Surgical intervention is generally recommended for aortic diameters > 45 mm, though thresholds differ if there are additional factors that confer risk (i.e. higher-risk genetic mutations, prior history of dissection, or growth rate). With blood pressure control, beta-blocker use (excluding atenolol) is recommended to mitigate risk, though recent registry data and meta-analysis have not shown clear reductions in dissection. Vaginal delivery is often preferred when appropriate, though cesarean delivery is considered in high-risk conditions due to intra-abdominal pressures. Summary Preconception risk stratification, multidisciplinary ‘pregnancy heart teams’, and structured imaging surveillance remain essential to reducing maternal and fetal morbidity in aortopathy. Gaps currently exist in protocolized postpartum follow-up, outcome data surrounding delivery method and beta blocker use, and long-term data on assisted reproductive technology in these high-risk populations. Beyond further outcomes research, continued efforts to broaden access to multidisciplinary cardio-obstetric care teams should remain a priority to improve maternal health.