A new American Heart Association scientific statement published today in the journal Circulation underscores the critical need for increased awareness and timely diagnosis of heart failure in pregnant and postpartum women. The statement, titled "Heart Failure Occurring in the Perinatal Period," notes that heart disease is now one of the leading causes of pregnancy-related death in the U.S., yet heart failure symptoms such as shortness of breath, fatigue, and swelling are often dismissed as normal pregnancy discomforts.
According to the statement, nearly 1 in 4 women aged 20-44 currently has some form of cardiovascular disease, and heart failure poses substantial risks to both mother and baby. Delays in recognition can lead to life-threatening complications, including irregular heartbeat, stroke, and death. Data from a national database indicate 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.
"Heart failure during and after pregnancy is often hiding in plain sight," said Demilade A. Adedinsewo, M.D., M.P.H., chair of the 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 emphasizes that the postpartum period, extending through the first year after delivery, is a particularly high-risk time for developing heart failure. Some women experience symptoms within days, while others develop them weeks or months later. Continued monitoring beyond the traditional six-week postpartum visit is essential, including home visits, telemedicine, and remote symptom assessments.
Risk factors for perinatal heart failure include pre-existing cardiovascular disease, high blood pressure, type 2 diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology. Significant racial disparities exist: Black adults have about a 19% higher risk of developing heart failure than white adults, and Black women with peripartum cardiomyopathy are more likely to be diagnosed later. Heart failure contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.
Diagnosis requires prompt evaluation with electrocardiograms, blood tests for cardiac biomarkers, and echocardiograms to distinguish between normal pregnancy changes and warning signs. Treatment involves medications such as beta blockers, diuretics, and vasodilators, which may be safe during pregnancy, along with a multidisciplinary cardio-obstetrics team for continuous monitoring.
The statement also highlights the importance of contraception counseling for postpartum women with heart failure. Long-acting reversible contraceptives, specifically hormonal intrauterine devices, are preferred, while estrogen-containing methods are not recommended due to increased thrombosis risk.
"Improving postpartum care is essential to protecting maternal health. Standardized screening, listening carefully to patient concerns and improved access to care are crucial to help improve outcomes for mothers and their families," Adedinsewo said.
The full statement is available online in the American Heart Association's journal Circulation. Additional resources include the Association's Life's Essential 8 metrics for cardiovascular health and the Advancing Maternal Health Initiative at heart.org.
