Gaps in heart healthcare putting pregnant women at risk, leading cardiologist warns

A leading heart specialist is calling for greater access to life-saving cardiac care for pregnant women in New Zealand to prevent harm to mothers and babies.

Dr Sarah Fairley, Medical Director of Kia Manawanui Trust - The Heart of Aotearoa and Interventional Obstetric Cardiologist, says current gaps in care put many women - especially those living in rural areas - at risk of complications during pregnancy.

There is also increased risk of cardiac events later in life in those women who have experienced an adverse pregnancy outcome, including pre-eclampsia, gestational diabetes, hypertension (high blood pressure), pre-term birth, and fetal growth restriction or worse, Dr Fairley says.

"The problem we have in New Zealand is not a lack of expertise, it is less awareness of what constitutes a high-risk pregnancy, issues with access to streamlined funded services, and awareness of the importance of post-partum follow-up for women who have had cardiac issues during pregnancy."

Pregnancy places major stress on the heart.

For women with known or previously undiagnosed heart disease, this can turn into a high-risk situation without access to specialist expertise and tests, Dr Fairley says.

Typically, this risk is addressed through Pregnancy Heart Teams: dedicated multidisciplinary teams that manage women with heart disease from before pregnancy, through pregnancy, delivery, and the postpartum period.

These teams were first recommended in the 2018 European Society of Cardiology (ESC) guidelines. The 2025 ESC guidelines now state that Pregnancy Heart Teams should be established in all referral hospitals, with care spanning pre-pregnancy through to post-partum follow-up.

Trust Chief Executive Ms Letitia Harding says that while major hospitals in New Zealand have these teams, access to them remains inconsistent and often depends on where a woman lives rather than on her level of risk.

"Right now, some women get world-class multidisciplinary care, and others don’t - not because their risk is different, but because of the postcode lottery.

"Delays and ad-hoc referrals can have life-threatening consequences for both mother and baby."

Pregnant women in rural New Zealand face serious risks because there is no clear, nationally consistent pathway to access specialist heart care, Ms Harding says.

That’s why the Trust is calling for a nationally-mandated referral pathway so women with known or suspected cardiac risk can access care rapidly.

Globally, cardiovascular disease is the leading cause of death in women.