DALLAS - According to a new American Heart Association scientific statement published today in the journal Circulation, recognizing heart failure symptoms during pregnancy and the postpartum period is critical to preventing serious complications such as irregular heartbeat, stroke, and death. The statement, “Heart Failure Occurring in the Perinatal Period,” underscores that heart failure is a leading cause of pregnancy-related death in the U.S., with nearly 1 in 4 women aged 20-44 currently having some type of cardiovascular disease.
Heart failure symptoms like shortness of breath, fatigue, and swelling are often mistaken for common pregnancy discomforts, delaying diagnosis and treatment. This can have life-threatening consequences for both mother and baby. The first year after delivery is a particularly high-risk time for women to develop heart failure, necessitating ongoing follow-up care beyond the traditional six-week postpartum period.
“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. “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 high blood pressure, Type 2 diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology. Significant disparities exist: Black adults have about a 19% higher risk of developing heart failure than white adults, and Black women are more frequently diagnosed with peripartum cardiomyopathy (PPCM) and at later stages. 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 with medications such as beta blockers, diuretics, and vasodilators may be safe during pregnancy, and a multidisciplinary cardio-obstetrics team is critical for optimal care.
The postpartum period extends through the first year after delivery, and continued monitoring may include home visits, telemedicine, and digital technologies for remote symptom assessment. Counseling about contraception is also important; long-acting reversible contraceptives like hormonal intrauterine devices are preferred for women with cardiovascular disease.
“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,” said Adedinsewo.
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 on pregnancy and maternal health, visit the American Heart Association’s pregnancy and maternal health page.
The full scientific statement is available online.
