A new scientific statement from the American Heart Association, published today in the journal Circulation, underscores the urgent need for early detection and treatment of heart failure in pregnant and postpartum women to prevent serious complications, including irregular heartbeat, stroke, and death. The statement, titled “Heart Failure Occurring in the Perinatal Period,” highlights that heart failure symptoms such as shortness of breath, fatigue, and swelling are often dismissed as normal pregnancy discomforts, delaying diagnosis and care.
Heart failure affects the heart's ability to pump blood effectively, leading to fluid buildup that can impair the lungs, kidneys, and brain. According to the statement, nearly 1 in 4 women aged 20-44 in the U.S. has some form of cardiovascular disease, and heart disease is now a leading cause of pregnancy-related death. The first year after delivery is particularly high-risk for developing heart failure, yet many women do not receive adequate follow-up care.
“Heart failure during and after pregnancy is often hiding in plain sight,” said Dr. Demilade A. Adedinsewo, chair of the statement writing group. “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.”
Risk factors for perinatal heart failure include pre-existing cardiovascular disease, high blood pressure, diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology. Significant disparities exist: Black women have a 19% higher risk of developing heart failure than white women, and Black and Native American women are more frequently diagnosed with peripartum cardiomyopathy (PPCM), a form of heart failure that can develop late in pregnancy or after delivery. Black women with PPCM are also more likely to be diagnosed later.
Delays in diagnosis can be deadly. 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, preterm delivery, and poor outcomes for the baby, such as restricted growth and stillbirth.
Diagnostic tools like electrocardiograms, blood tests for cardiac biomarkers, and echocardiograms can help distinguish normal pregnancy changes from heart failure. Treatment includes medications such as beta blockers and diuretics, which may be safe during pregnancy, and a multidisciplinary cardio-obstetrics team is recommended for continuous monitoring.
The postpartum period is critical. Referrals to cardiologists or primary care providers are essential beyond the traditional six-week checkup. Telemedicine and remote monitoring can aid in follow-up care. Contraception counseling is also important, with long-acting reversible contraceptives like hormonal intrauterine devices preferred for women with heart failure, while estrogen-containing methods are not recommended due to thrombosis risk.
“Improving postpartum care is essential to protecting maternal health,” Adedinsewo said. “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 emphasizes that achieving optimal cardiovascular health, as outlined by the American Heart Association’s Life’s Essential 8 metrics, is important before, during, and after pregnancy. For more information, visit the American Heart Association’s Life’s Essential 8 page and their Pregnancy and Maternal Health resource.
