A new scientific statement from the American Heart Association, published today in the journal Circulation, calls for increased awareness of heart failure symptoms during pregnancy and the postpartum period. The statement highlights that heart failure is often underdiagnosed because its symptoms—such as shortness of breath, fatigue, and swelling—mimic common pregnancy discomforts. Delayed recognition can lead to serious complications including irregular heartbeat, stroke, and death for both mother and baby.
According to the statement, nearly 1 in 4 women aged 20-44 currently has some form of cardiovascular disease, and heart disease is a leading cause of pregnancy-related death in the U.S. The first year after delivery is especially high-risk for developing heart failure, yet many women do not receive adequate follow-up care beyond the traditional six-week postpartum visit.
“Heart failure during and after pregnancy is often hiding in plain sight,” said Dr. Demilade A. Adedinsewo, chair of the writing group. “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. Significant disparities exist: Black women have about 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 occurs late in pregnancy or after delivery.
Diagnosis requires prompt evaluation with electrocardiograms, blood tests for cardiac biomarkers, and echocardiograms to distinguish heart failure from normal pregnancy changes. Treatment may include beta blockers, diuretics, and vasodilators considered safe in pregnancy, along with multidisciplinary care from a cardio-obstetrics team.
The statement emphasizes that postpartum care must extend beyond six weeks, with continued monitoring through the first year after delivery. Telemedicine and home visits can help. Contraception counseling is also important; long-acting reversible contraceptives like hormonal intrauterine devices are 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,” said Dr. 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 full statement is available on the Circulation journal website. Additional resources include the American Heart Association’s Pregnancy and Maternal Health page.
