The 2025 ESC Pregnancy Guidelines demonstrated an overall Certainty Index of 0.58 (78.8% Certainty), with 89.4% of recommendations supported by Evidence C.
The 2025 ESC Guidelines for Cardiovascular Disease in Pregnancy provide a solid foundation for clinical decision-making despite being predominantly supported by Level C evidence.
Objective: Objective: Human pregnancy-related cardiovascular diseases (CVD) are unique and difficult to study, primarily due to ethical constraints and the risk of unexpected harm. Consequently, limited data and mechanistic insights are available, hindering the development of comprehensive clinical guidelines. Previously, we developed a mathematical method to measure the efficacy of clinical Guidelines and demonstrated that the level of guidance provided is not evenly distributed across diseases. In the present study, we applied this mathematical method to analyze the helpfulness of the 2025 ESC Guidelines for the Management of Cardiovascular Disease in Pregnancy (2025-ESC-Pregnancy GL). Design and method: Design and Methods: A total of 208 Recommendations and corresponding Evidence levels were analyzed, of which 161 Recommendations addressed specific CVDs. To assess the helpfulness of the Guideline, we calculated the Certainty/Uncertainty ratio and formulated a Certainty Index (CI), ranging from minus 1 to plus 1. Results: Results: The 2025-ESC-Pregnancy GL comprised 64.4% Class I (is recommended/is indicated) and Class III (is not recommended) Recommendations. Recommendations related to CVD similarly showed a high proportion of these classes (62.7%). Both the overall Guideline and CVD-specific Recommendations were predominantly supported by Evidence C (89.4%). Recommendations supported by Evidence A were exclusively Class I, while Evidence B was mainly associated with Class I and Class IIb (maybe considered) Recommendations. The overall CI of the 2025-ESC-Pregnancy GL was 0.58, corresponding to 78.8% Certainty, whereas CVD-specific Recommendations demonstrated a CI of 0.61, corresponding to 80.8% Certainty. Conclusions: Conclusions: Like the 2018 Guidelines, the 2025-ESC-Pregnancy GL contains relatively few high-quality Evidence levels (Evidence A and B) linked to Class I Recommendations. Nevertheless, the higher overall level of Certainty provides a solid foundation for informed clinical decision-making across various pathological conditions during pregnancy. The limited availability of high-quality Evidence underscores the need for further human investigations incorporating novel biomarkers, wearable technologies, and artificial intelligence to generate additional Evidence A and B, thereby improving future guidelines for the prevention, treatment, and rehabilitation of pregnancy-related cardiovascular diseases.
Koller et al. (Fri,) conducted a other in Cardiovascular disease in pregnancy (n=208). Mathematical method to calculate Certainty Index was evaluated on Certainty Index (CI). The 2025 ESC Pregnancy Guidelines demonstrated an overall Certainty Index of 0.58 (78.8% Certainty), with 89.4% of recommendations supported by Evidence C.