Antenatal cardiac risk, postpartum follow-up with Garima Sharma, MD

Antenatal risk assessment and structured postpartum follow-up are central to managing cardiovascular risk in pregnancy, according to Garima Sharma, MD, Martha Schar Chair of Women’s Cardiovascular Health and Director of Preventive Cardiology and Women’s Cardiovascular Health at Inova Schar Heart and Vascular.

Building on her discussion of the cardio-obstetrics team model,^1,2 Sharma said that for patients with an established obstetrician or maternal-fetal medicine specialist, the first step is antenatal screening and risk assessment.

Antenatal screening and validated risk scores

Several validated, published risk scores endorsed by professional and scientific organizations are routinely used in cardio-obstetrics, she said, including the modified WHO classification of heart disease and CARPREG II. These lesion- or disease-specific tools help clinicians anticipate problems a patient may face based on a specific cardiac condition and should be incorporated into the antenatal care pathway, stated Sherma.³

Other screening pathways endorsed by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, such as the California Maternal Quality Care Collaborative (CMQCC) pathway, can also guide care.⁴

Clinicians should watch for signs of cardiac decompensation, Sharma said, including increased shortness of breath, dyspnea on exertion, palpitations, changes in blood pressure, an elevated heart rate, or very low blood pressure.

“These clinical signs and symptoms should not be dismissed,” Sharma said. “They should prompt the clinician to take a more detailed history and perform appropriate testing during pregnancy, whether that involves biomarkers, an echocardiogram, or an EKG, depending on the severity of the symptoms.”

“Cardiologists should be involved early in the patient’s care because some patients may not know they have underlying heart disease and may present with it for the first time during pregnancy,” Sharma said. For patients without a known cardiac history, she added, signs of heart failure or decompensation should likewise prompt additional testing and early involvement of cardiology, internal medicine, or primary care.

Preventing loss to follow-up after delivery

Adverse pregnancy outcomes can arise during pregnancy or delivery in patients with no prior history, Sharma said, and conditions such as preeclampsia, preterm birth, or gestational diabetes may appear for the first time or follow preexisting cardiac risk factors.

After delivery, she said, clinicians need to communicate future health risks to the patient and her family and establish a clear plan to transition her care from obstetrics to primary care, internal medicine, or cardiology.

“We need to make sure these patients are not lost to follow-up because they need postpartum screening, ongoing care, and optimization of their health,” Sharma said. “Unfortunately, these needs are not adequately addressed within the framework of current obstetrical care.”

References:

1. Inova experts highlight critical connections between pregnancy and heart health in preeminent international medical journal. Inova. News release. Published September 1, 2026. Accessed October 8, 2026. https://www.inovanewsroom.org/press-release/2026/09/inova-experts-highlight-critical-connections-between-pregnancy-and-heart-health-in-preeminent-international-medical-journal/
2. Fitch J. Garima Sharma, MD, on cardio-obstetrics framework, cardiovascular risk. Contemporary OB/GYN. Published October 8, 2026. Accessed October 12, 2026. https://www.contemporaryobgyn.net/view/garima-sharma-md-cardio-obstetrics-framework-cardiovascular-risk
3. Sorrenti S, Zullo F, D’Alberti E, et al. Maternal and perinatal outcomes of pregnancy in patients with cardiac disease according to the modified World Health Organization classification: systematic review and meta-analysis. American Journal of Obstetrics & Gynecology: Maternal-Fetal Medicine. Published July 2026. Accessed October 12, 2026. https://www.ajogmfm.org/article/S2589-9333(26)00088-1/fulltext
4. California maternal quality of care collaborative tool kits. American College of Obstetricians & Gynecologists. Accessed October 12, 2026. https://www.acog.org/community/districts-and-sections/district-ix/programs-and-resources/california-maternal-quality-care-collaborative-toolkits