{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T06:27:10Z","timestamp":1786602430909,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Cardiovascular disease is a major contributor to maternal morbidity and mortality, and many pregnancy-related cardiovascular deaths are potentially preventable. Cardio-obstetrics has advanced preconception counseling, multidisciplinary care, and risk stratification, but a structured preconception cardiovascular intervention model remains undeveloped. This structured narrative review synthesizes recent cardiovascular, exercise, lifestyle, and implementation evidence and proposes preconception cardiac rehabilitation (PCR) as a testable conceptual framework. Structured searches of PubMed, Scopus, Web of Science, Cochrane Library, CNKI, and Wanfang supported purposive selection of 39 key sources published from 2020 to 2026. A narrative evidence map organized the curated literature by reproductive phase, intervention type, outcome domain, and evidence level; it was not designed as a formal systematic evidence gap map. No study directly evaluated integrated PCR. Indirect evidence suggests that preconception physical activity and cardiorespiratory fitness may be associated with lower risks of several adverse pregnancy outcomes, whereas evidence for fetal growth restriction remains particularly limited. PCR is therefore presented as cardiovascular prehabilitation for pregnancy, not as a validated care model. The revised framework specifies candidate eligibility groups, referral routes, responsible disciplines, follow-up points, implementation barriers, and equity considerations. Consensus development, feasibility studies, cost and implementation evaluations, and randomized trials are needed before clinical adoption.<\/jats:p>","DOI":"10.3389\/fmed.2026.1914342","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:32:50Z","timestamp":1786599170000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preconception cardiac rehabilitation: a structured narrative review and conceptual framework for maternal cardiovascular health and fetal growth"],"prefix":"10.3389","volume":"13","author":[{"given":"Jianxia","family":"Cheng","sequence":"first","affiliation":[{"name":"First People's Hospital of Jiande City","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Yu","sequence":"additional","affiliation":[{"name":"First People's Hospital of Jiande City","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junsen","family":"Ye","sequence":"additional","affiliation":[{"name":"First People's Hospital of Jiande City","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e76","DOI":"10.1161\/CIR.0000000000001124","article-title":"Optimizing prepregnancy cardiovascular health to improve outcomes in pregnant and postpartum individuals and offspring: a scientific statement from the American heart association","volume":"147","author":"Khan","year":"2023","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1097\/AOG.0000000000006297","article-title":"Cardiovascular-related maternal mortality","volume":"147","author":"Levine","year":"2026","journal-title":"Obstet Gynecol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"115213","DOI":"10.1016\/j.ejogrb.2026.115213","article-title":"A blueprint of an integrated cardio-obstetric preconception care pathway for women with pre-pregnancy intermediate- to high-risk cardiovascular disease","volume":"324","author":"Vanharen","year":"2026","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e884","DOI":"10.1161\/CIR.0000000000000772","article-title":"Cardiovascular considerations in caring for pregnant patients: a scientific statement from the American heart association","volume":"141","author":"Mehta","year":"2020","journal-title":"Circulation"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e902\u2013e916","DOI":"10.1161\/CIR.0000000000000961","article-title":"Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association","volume":"143","author":"Parikh","year":"2021","journal-title":"Circulation"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"101127","DOI":"10.1016\/j.preghy.2024.101127","article-title":"Hypertensive disorders of pregnancy and long-term maternal cardiovascular risk: bridging epidemiological knowledge into personalized postpartum care and follow-up","volume":"36","author":"Staff","year":"2024","journal-title":"Pregnancy Hypertens"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"314.e1","DOI":"10.1016\/j.ajog.2024.05.031","article-title":"Prepregnancy physiology and subsequent preterm preeclampsia","volume":"232","author":"Bernstein","year":"2025","journal-title":"Am J Obstet Gynecol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e328","DOI":"10.1161\/CIR.0000000000001289","article-title":"Core components of cardiac rehabilitation programs: 2024 update: a scientific statement from the American heart association and the American association of cardiovascular and pulmonary rehabilitation","volume":"150","author":"Brown","year":"2024","journal-title":"Circulation"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.tcm.2024.10.005","article-title":"Cardio obstetrics: bridging heart and pregnancy health","volume":"35","author":"Goldberg","year":"2025","journal-title":"Trends Cardiovasc Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1007\/s11886-023-01928-0","article-title":"Cardio-obstetrics: a focused review","volume":"25","author":"Misra","year":"2023","journal-title":"Curr Cardiol Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1016\/j.jacc.2021.02.033","article-title":"Team-based care of women with cardiovascular disease from pre-conception through pregnancy and postpartum","volume":"77","author":"Davis","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ccl.2020.09.002","article-title":"The importance of cardiovascular risk assessment and pregnancy heart team in the management of cardiovascular disease in pregnancy","volume":"39","author":"Sharma","year":"2021","journal-title":"Cardiol Clin"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e002099","DOI":"10.1136\/bmjsem-2024-002099","article-title":"Cardiovascular effects of exercise training in pregnant people with a high body mass index: secondary results from a randomised controlled trial (ETIP)","volume":"10","author":"Moholdt","year":"2024","journal-title":"BMJ Open Sport Exerc Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.3390\/nu13031036","article-title":"The effectiveness of smoking cessation, alcohol reduction, diet and physical activity interventions in improving maternal and infant health outcomes: a systematic review of meta-analyses","volume":"13","author":"Hayes","year":"2021","journal-title":"Nutrients"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4364","DOI":"10.3390\/jcm11154364","article-title":"Association between cardiorespiratory fitness and hypertensive disorders of pregnancy: a systematic review and meta-analysis","volume":"11","author":"Al-Huda","year":"2022","journal-title":"J Clin Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1111\/ajo.70032","article-title":"Pre-pregnancy diet and\/or physical activity interventions for the prevention of gestational diabetes mellitus: a systematic review and meta-analysis","volume":"65","author":"Poprzeczny","year":"2025","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1007\/s10995-025-04086-7","article-title":"Preconception physical activity and maternal health outcomes: an integrative review of studies from 2016\u20132025","volume":"29","author":"Murrell","year":"2025","journal-title":"Matern Child Health J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1017\/S1368980018002616","article-title":"Maternal dietary patterns and risk of adverse pregnancy (hypertensive disorders of pregnancy and gestational diabetes mellitus) and birth (preterm birth and low birth weight) outcomes: a systematic review and meta-analysis","volume":"22","author":"Kibret","year":"2019","journal-title":"Public Health Nutr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"103395","DOI":"10.1016\/j.eclinm.2025.103395","article-title":"The effect of maternal pre-pregnancy body mass index on hypertensive disorders of pregnancy (HDP): a systematic review and dose-response meta-analysis of cohort studies involving 50 million pregnancies","volume":"86","author":"Xiong","year":"2025","journal-title":"EClinicalMedicine"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1111\/1471-0528.15661","article-title":"Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, north American and Australian cohorts","volume":"126","author":"Santos","year":"2019","journal-title":"BJOG Int J Obstet Gynaecol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1111\/ppe.12855","article-title":"Preconception exposures and adverse pregnancy, birth and postpartum outcomes: umbrella review of systematic reviews","volume":"36","author":"Daly","year":"2022","journal-title":"Paediatr Perinat Epidemiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1097\/AOG.0000000000005346","article-title":"Prepregnancy healthy lifestyle and adverse pregnancy outcomes","volume":"142","author":"Wang","year":"2023","journal-title":"Obstet Gynecol"},{"key":"ref23","volume-title":"A Prospective Longitudinal Study of Maternal Cardiovascular Function From Pre-conception to Post-partum: The CONCEIVE Study [Doctoral Dissertation]","author":"Foo","year":"2019"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e032673","DOI":"10.1161\/JAHA.123.032673","article-title":"Third-trimester cardiovascular function and risk of hypertensive disorders of pregnancy","volume":"13","author":"Lihme","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2223","DOI":"10.1042\/CS20171036","article-title":"The influence of prenatal exercise and pre-eclampsia on maternal vascular function","volume":"131","author":"Skow","year":"2017","journal-title":"Clin Sci"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3389\/fphar.2014.00209","article-title":"Physiological mechanisms of vascular response induced by shear stress and effect of exercise in systemic and placental circulation","volume":"5","author":"I","year":"2014","journal-title":"Front Pharmacol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"902634","DOI":"10.3389\/fmed.2022.902634","article-title":"Maternal low volume circulation relates to normotensive and preeclamptic fetal growth restriction","volume":"9","author":"Gyselaers","year":"2022","journal-title":"Front Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e661","DOI":"10.1161\/CIR.0000000000001292","article-title":"Assessing and addressing cardiovascular and obstetric risks in patients undergoing assisted reproductive technology: a scientific statement from the American heart association","volume":"151","author":"Mauricio","year":"2025","journal-title":"Circulation"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.ccl.2020.09.012","article-title":"Delivering coordinated cardio-obstetric care from preconception through postpartum","volume":"39","author":"O\u2019Kelly","year":"2021","journal-title":"Cardiol Clin"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1093\/humupd\/dmaf021","article-title":"Preconception lifestyle interventions for women\u2014a systematic review and meta-analysis of intervention characteristics and behaviour change techniques","volume":"32","author":"Torkel","year":"2026","journal-title":"Hum Reprod Update"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1007\/s43032-024-01635-3","article-title":"Association between life\u2019s essential 8 and infertility as well as the mediating effects of oxidative stress and inflammatory factors among U.S. women aged 18\u201345 years","volume":"32","author":"Zhuang","year":"2025","journal-title":"Reprod Sci"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1380639","DOI":"10.3389\/fcvm.2024.1380639","article-title":"Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice","volume":"11","author":"Milani","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.3390\/healthcare13091037","article-title":"Effectiveness of web-based interventions on clinical outcomes and lifestyle modifications in women planning to conceive: a systematic review","volume":"13","author":"Suzuki","year":"2025","journal-title":"Health Care (Don Mills)"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e330","DOI":"10.1161\/CIR.0000000000001212","article-title":"Opportunities in the postpartum period to reduce cardiovascular disease risk after adverse pregnancy outcomes: a scientific statement from the American Heart Association","volume":"149","author":"Lewey","year":"2024","journal-title":"Circulation"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"4462","DOI":"10.1093\/eurheartj\/ehaf193","article-title":"2025 ESC guidelines for the management of cardiovascular disease and pregnancy","volume":"46","author":"De Backer","year":"2025","journal-title":"Eur Heart J"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Admin Pol Ment Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: the RE-AIM framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am J Public Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated consolidated framework for implementation research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.puhe.2024.12.036","article-title":"Preconception care interventions among adolescents and young adults to prevent adverse maternal, perinatal and child health outcomes: an evidence gap map","volume":"239","author":"Padhani","year":"2025","journal-title":"Public Health (Lond)"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1914342\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:32:51Z","timestamp":1786599171000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1914342\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":39,"alternative-id":["10.3389\/fmed.2026.1914342"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1914342","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"article-number":"1914342"}}