Impact of pregnancy on pre-existing medical conditions
How the haemodynamic, renal, immune, coagulation and pharmacokinetic changes of pregnancy predict what happens to heart disease, CKD, epilepsy, autoimmune disease, diabetes and other conditions, with worked examples (mitral stenosis gradient, lamotrigine clearance, creatinine), mWHO 2.0 and CARPREG II from the 2025 ESC guideline, and the conditions that improve, worsen or flare after birth.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Pregnancy is a physiological stress test. Predict the effect on any condition from five changes: volume and cardiac output, renal hyperfiltration, hypercoagulability, immune modulation and altered drug handling.
- Lesions that can't increase output (stenotic valves, pulmonary hypertension, poor ventricles) decompensate. Regurgitant lesions and shunts often do well.
- Th2-shifted immunity improves RA and MS during pregnancy, while both flare after birth. SLE tends to flare.
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Sources
- 2025 ESC Guidelines for the management of cardiovascular disease and pregnancyEuropean Society of Cardiology, Eur Heart J 2025, 2025 (replaces the 2018 ESC guideline; introduces mWHO 2.0)
- Silversides CK et al. Pregnancy outcomes in women with heart disease: the CARPREG II study. J Am Coll Cardiol 2018;71:2419-2430Journal of the American College of Cardiology, 2018
- SOMANZ Hypertension in Pregnancy Guideline 2023AU/NZSociety of Obstetric Medicine of Australia and New Zealand, 2023 (current, November 2026)
- Pennell PB et al. Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency. Neurology 2008;70:2130-2136Neurology, 2008
- Confavreux C et al. Rate of pregnancy-related relapse in multiple sclerosis (PRIMS). N Engl J Med 1998;339:285-291New England Journal of Medicine, 1998
- de Man YA et al. Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study (PARA). Arthritis Rheum 2008;59:1241-1248Arthritis and Rheumatism, 2008
- de Swiet's Medical Disorders in Obstetric Practice (5th ed.)Wiley-Blackwell (Powrie, Greene and Camann, eds), 2010
- Jones DC, Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med 1996;335:226-232New England Journal of Medicine, 1996
- Last updated
- 14 November 2026
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