Preconception cardiac rehabilitation: a structured narrative review and conceptual framework for maternal cardiovascular health and fetal growth

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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.