Sub-Saharan Africa (SSA) accounted for nearly 70% of global maternal deaths in 2023. As mortality from direct obstetric causes declines, cardiovascular disease is emerging as an increasingly important yet underrecognized contributor to maternal morbidity and mortality. The regional burden includes rheumatic and congenital heart disease, peripartum cardiomyopathy, hypertensive disorders of pregnancy, and HIV-associated cardiovascular disease. Adverse outcomes are exacerbated by delayed recognition, limited diagnostic capacity, workforce shortages, fragmented referral pathways, and restricted access to cardiac interventions.

Cardio-obstetric programs provide a coordinated, multidisciplinary model across preconception, pregnancy, delivery, and postpartum care. These programs facilitate early diagnosis, structured risk stratification, individualized management, coordinated delivery planning, and longitudinal follow-up.

Our experience from multidisciplinary clinics in Ethiopia and Tanzania demonstrates the feasibility of adapting cardio-obstetric principles to resource-constrained health systems. We propose a scalable framework comprising five interconnected pillars: early diagnosis and risk stratification; multidisciplinary team-based care; regional referral networks; telemedicine and digital health; and research and capacity building. Implementation should integrate cardiovascular care into existing maternal health services while strengthening diagnostic capacity, workforce development, referral infrastructure, and locally generated evidence. Context-adapted cardio-obstetric pathways may therefore provide a practical, scalable approach to reducing preventable cardiovascular maternal deaths and advancing equitable maternal health across SSA.

Cardio-obstetrics, Maternal mortality, Sub-Saharan Africa, Cardiovascular disease in pregnancy, Peripartum cardiomyopathy