The American Heart Association has released a new scientific statement, “Heart Failure Occurring in the Perinatal Period,” underscoring the urgent need for early detection and treatment of heart failure in pregnant and postpartum women. The statement, published in the journal Circulation, highlights that heart failure symptoms such as shortness of breath, fatigue, and swelling are frequently dismissed as normal pregnancy discomforts, potentially leading to severe complications including arrhythmia, stroke, and death.
According to the statement, nearly 1 in 4 women aged 20-44 currently have some form of cardiovascular disease, and heart disease is a leading cause of pregnancy-related death in the U.S. Data from the CDC’s Pregnancy Mortality Surveillance System show that heart disease contributes significantly to maternal mortality, with heart failure or abnormal cardiac function responsible for 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women. The statement notes that Black adults have a 19% higher risk of developing heart failure than white adults, and Black women with peripartum cardiomyopathy are often diagnosed later than other racial groups.
“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.” The postpartum period, extending through the first year after delivery, is identified as a particularly high-risk time for developing heart failure, with some women experiencing symptoms weeks or months after childbirth.
The statement emphasizes that standard screening tools such as electrocardiograms, blood tests for cardiac biomarkers, and echocardiograms can help differentiate between normal pregnancy changes and heart failure. It recommends a multidisciplinary cardio-obstetrics team approach for continuous monitoring and treatment. Medications considered safe during pregnancy include beta blockers, diuretics, vasodilators, and anticoagulants when appropriate. Additionally, achieving optimal cardiovascular health as outlined by the American Heart Association’s Life’s Essential 8 metrics is crucial before, during, and after pregnancy.
For postpartum care, the statement stresses ongoing follow-up beyond the traditional six-week checkup, including home visits, telemedicine, and remote monitoring. Counseling on contraception is also important; long-acting reversible contraceptives, particularly hormonal intrauterine devices, are preferred for women with cardiovascular disease, while estrogen-containing methods are not recommended for those with moderate or severe heart failure due to thrombosis risk.
The statement highlights significant racial and ethnic disparities in perinatal heart failure risk and outcomes. It calls for standardized screening, attentive listening to patient concerns, and improved access to care to address these inequities. “Improving postpartum care is essential to protecting maternal health,” Adedinsewo added.
The full scientific statement is available online. Additional resources include the American Heart Association’s Pregnancy and Maternal Health page and the Advancing Maternal Health Initiative.
