A Scoping Review of Clinical Guidelines for the Management of Cardiovascular Diseases (CVD) in Pregnancy in Low- and Middle-Income Countries (LMIC).

Cardiovascular diseases (CVD), including pre-existing cardiac conditions and hypertensive disorders of pregnancy, are among the leading causes of maternal mortality globally and account for a substantial proportion of preventable deaths in low- and middle-income countries (LMICs). In these settings, women are disproportionately affected by conditions such as rheumatic heart disease, peripartum cardiomyopathy, and severe anemia-related heart failure, yet clinical guidance tailored to LMICs contexts remains limited. This paper presents the findings of a scoping review on CVD in pregnancy guidelines in LMICs. The review seeks to identify and map clinical guidelines from LMICs and international organizations with reach in LMICs that addresses the prevention, screening, and management of cardiovascular diseases (CVD) in pregnancy and examine their scope, content, and specific recommendations for pregnant women. The review followed the JBI methodology. Guidelines on CVD care in pregnancy published between 2011 and 2023 by international or national professional organizations and Ministries of Health from LMICs were searched using databases such as PubMed, Scopus, GIN International library, and individual websites. Data were extracted using a custom-designed MS Excel form, capturing details such as guideline title, year, type, publisher, country, target audience and population, clinical focus, timing, and summary of recommendations. Out of the 90 shortlisted guidelines, 17 were included and 73 were excluded. Of the included guidelines, 3 are on CVDS and 14 are on hypertensive disorders of pregnancy (HDP). They varied in scope, with most focusing on preeclampsia or HDP, but only a few provided comprehensive recommendations across the continuum of cardiovascular care in pregnancy, highlighting major gaps in prevention, screening, and long-term follow-up. Existing guidance remains fragmented with limited coverage of high-burden conditions of LMICs such as rheumatic heart disease. Strengthening clinical practice will require not only adapting global recommendations to local realities but also investing in LMIC-led research and inclusive guideline development that reflects regional priorities and health system capacities.