The American Heart Association has released a new scientific statement emphasizing the importance of early detection and timely treatment of heart failure in pregnant and postpartum women to prevent serious complications, including irregular heartbeat, stroke, and death. Published today in the Association's flagship journal Circulation, the statement, “Heart Failure Occurring in the Perinatal Period,” addresses the challenges of recognizing heart failure in this population and underscores the need for prompt treatment and continued monitoring after delivery.
Heart failure, a condition where the heart cannot pump enough blood to meet the body's needs, often presents symptoms such as shortness of breath, fatigue, and swelling—symptoms that are also common in normal pregnancies. This overlap can delay diagnosis and treatment, with potentially life-threatening consequences for both mother and baby. According to the statement, nearly 1 in 4 women aged 20-44 currently have some type of cardiovascular disease, and data from the U.S. Centers for Disease Control and Prevention's Pregnancy Mortality Surveillance System indicate that heart disease is now one of the leading causes of pregnancy-related death in the U.S.
“Heart failure during and after pregnancy is often hiding in plain sight,” said Demilade A. Adedinsewo, M.D., M.P.H., chair of the statement writing group and an assistant professor at the Mayo Clinic in Jacksonville, Florida. “By recognizing symptoms earlier and initiating appropriate treatment, especially in the postpartum period, clinicians and health systems have a powerful opportunity to prevent serious complications and save mothers’ lives.”
The statement highlights that heart failure can affect women with or without pre-existing cardiovascular disease. Risk factors include high blood pressure, Type 2 diabetes, abnormal cholesterol, overweight/obesity, and metabolic syndrome. During the perinatal period, unique risk factors include known heart disease prior to pregnancy, older maternal age, multiple gestation, genetic variants, use of assisted reproductive technology, and prolonged use of tocolytic agents. Among women with known heart disease, heart failure is the most common complication, affecting 11% during pregnancy and postpartum.
Significant racial disparities exist in perinatal heart failure risk and outcomes. Black adults have about a 19% higher risk of developing heart failure than white adults. Black women and Native American women are more frequently diagnosed with peripartum cardiomyopathy (PPCM), a form of heart muscle failure that can develop late in pregnancy or after delivery. Black women with PPCM are also more likely to be diagnosed later. Heart failure or abnormal cardiac function contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.
Delays in diagnosis can be life-threatening. Data from a national database found that pregnant women with heart failure are about 32 times more likely to die around the time of delivery compared to those without heart failure. Other risks include irregular heartbeat, stroke, worsening cardiac function, preterm delivery, caesarean delivery, postpartum hemorrhage, and poor mental health. For the baby, risks include restricted fetal growth, premature birth, low birth weight, prolonged NICU stay, stillbirth, or death in the first four weeks of life.
Diagnosis requires prompt evaluation with tests such as electrocardiograms, blood tests for cardiac biomarkers, and echocardiograms to distinguish between normal pregnancy changes and heart failure warning signs. Treatment includes medications that may be safe in pregnancy, such as beta blockers, diuretics, vasodilators, and anticoagulants, along with a multidisciplinary cardio-obstetrics team. Achieving optimal cardiovascular health, as outlined by the Association's Life's Essential 8 metrics, is important before, during, and after pregnancy.
The postpartum period, extending through the first year after delivery, is a particularly high-risk time. Some women first experience symptoms within days, while others develop symptoms weeks or months after delivery. The statement emphasizes the need for continued monitoring beyond the traditional six-week postpartum visit, including home visits, telemedicine, and remote monitoring. Counseling about contraception is also important, with hormonal intrauterine devices preferred for women with cardiovascular disease, and estrogen-containing methods not recommended for those with moderate or severe heart failure due to increased thrombosis risk.
“Improving postpartum care is essential to protecting maternal health,” said Adedinsewo. “Standardized screening, listening carefully to patient concerns, and improved access to care are crucial to help improve outcomes for mothers and their families.” The statement, prepared by the volunteer writing group on behalf of the American Heart Association's Women's Health Science Committee, aims to promote greater awareness and help facilitate informed health care decisions. More information on the Association's efforts can be found at heart.org.
