The American Heart Association has released a new scientific statement emphasizing the critical need for early detection and timely treatment of heart failure in pregnant and postpartum women. The statement, titled “Heart Failure Occurring in the Perinatal Period,” highlights that symptoms such as shortness of breath, fatigue, and swelling are often mistaken for normal pregnancy discomforts, delaying diagnosis and increasing risks of complications including irregular heartbeat, stroke, and death.
According to the statement, published in the Association’s journal Circulation, heart disease is now one of the leading causes of pregnancy-related death in the U.S. Data from the CDC’s Pregnancy Mortality Surveillance System indicate that nearly 1 in 4 women aged 20-44 have some form of cardiovascular disease. The true prevalence of perinatal heart failure is unknown, but the condition poses substantial risks to both mother and baby.
“Heart failure during and after pregnancy is often hiding in plain sight,” said Dr. Demilade A. Adedinsewo, chair of the writing group and assistant professor at Mayo Clinic. “By recognizing symptoms earlier and initiating appropriate treatment, 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 heart disease, high blood pressure, diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology. Disparities are notable: Black adults have a 19% higher risk of developing heart failure than white adults, and Black women with peripartum cardiomyopathy are often diagnosed later. Heart failure contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.
If undiagnosed, heart failure can lead to maternal death, irregular heartbeat, stroke, preterm delivery, and poor fetal outcomes. Diagnostic tools such as electrocardiograms, blood tests, and echocardiograms can help differentiate heart failure from normal pregnancy changes. Management includes medications like beta blockers and diuretics, along with close monitoring by a multidisciplinary cardio-obstetrics team.
The postpartum period, especially the first year after delivery, is a high-risk time for developing heart failure. The statement emphasizes ongoing follow-up care beyond the traditional six-week visit, including telemedicine and remote monitoring. Contraception counseling is also important, with long-acting reversible contraceptives recommended for women with heart disease.
“Improving postpartum care is essential to protecting maternal health,” Adedinsewo noted. The statement calls for standardized screening, attentive listening to patient concerns, and improved access to care to reduce disparities and save lives.
For more information, visit the American Heart Association’s Pregnancy and Maternal Health page or the full manuscript.
