Garima Sharma, MD, on cardio-obstetrics framework, cardiovascular risk

Pregnancy represents a critical window for identifying and managing cardiovascular risk, from preconception through the postpartum period and into a woman’s later health, 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.

Sharma was a lead author of a new 3-part series on cardiovascular disease in pregnancy published in The Lancet and The Lancet Obstetrics, Gynaecology & Women’s Health, and presented the series introduction at the 2026 European Society of Cardiology Congress in Amsterdam on August 30.

“The core of the Lancet series was to focus on the emerging and changing paradigm of cardiovascular disease in pregnancy,” Sharma said.

The 3 papers address the global status of cardiovascular disease in pregnancy and team-based care pathways; hypertensive disorders of pregnancy and the early postpartum period as a window of opportunity; and adverse pregnancy outcomes—including preeclampsia, preterm birth, gestational diabetes, placental abruption, and small-for-gestational-age infants—and their effects on maternal and offspring health. Hypertensive disorders affect an estimated 5% to 10% of pregnancies worldwide, per the series.

Identifying patients who need a cardio-obstetrics team

Sharma said the team-based model should flag patients with multiple cardiovascular risk factors—hypertension, diabetes, high cholesterol, obesity, arrhythmias, or established disease such as heart failure, valvular disease, or congenital heart disease, whether repaired or unrepaired.

“All of these cardiovascular conditions can worsen during the 40 weeks of pregnancy,” Sharma said. “They can lead to acute hospitalizations, arrhythmias, premature cardiac decompensation, and even fetal complications.”

The goal, she said, is to recognize risk early, stratify it, and anticipate which patients may decompensate so clinicians can adjust medications, arrange closer follow-up, obtain more detailed imaging, or involve a geneticist or other specialists.

Building a scalable program

Sharma emphasized that cardio-obstetrics is not a fixed structure. “It’s important to recognize that there is no one-size-fits-all model,” she said. “It’s a scalable program that may look very different across health systems and practices.”

A typical team includes a cardiologist, an obstetrician or maternal-fetal medicine specialist, and an anesthesiologist, with a geneticist for inherited conditions and, in many cases, intensivists, nurse navigators and nurses, social workers, and pharmacists. She also stressed continuity after delivery.

“It’s also important to ensure a warm handoff between maternal-fetal medicine and cardiology or primary care after delivery, so patients aren’t lost to follow-up,” Sharma said.

For clinicians unsure where to begin, “it’s important to recognize that this approach can be implemented in your own local setting,” she said. “You just need to put the different pieces of the team in place.”

Reference:

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/