A new scientific statement from the American Heart Association emphasizes that early detection and timely treatment of heart failure in pregnant or postpartum women are essential to prevent serious complications, including irregular heartbeat, stroke, and death. The statement, titled “Heart Failure Occurring in the Perinatal Period,” was published today in the journal Circulation.
Heart failure is a condition where the heart cannot pump enough blood to meet the body’s needs. The true prevalence during pregnancy and postpartum is unknown, but according to a 2026 American Heart Association scientific statement on forecasting cardiovascular disease in women, nearly 1 in 4 women aged 20-44 currently have some type of cardiovascular disease. Data from the U.S. Centers for Disease Control and Prevention’s Pregnancy Mortality Surveillance System indicates that heart disease is now one of the leading causes of pregnancy-related death in the U.S.
“Heart failure affects more than just the heart – it can affect the lungs, kidneys, brain and more,” said Demilade A. Adedinsewo, M.D., M.P.H., chair of the volunteer writing group and an assistant professor at the Mayo Clinic in Jacksonville, Florida. “Because blood flow is reduced and fluid builds up, it can lead to breathing difficulties, kidney issues, irregular heartbeats and increased risk of stroke and death.”
Symptoms of heart failure include shortness of breath, fatigue, and swelling in the legs and feet – symptoms that are also common in healthy pregnancies. This similarity often delays diagnosis and treatment, which can be life-threatening. Peripartum cardiomyopathy (PPCM), a form of heart muscle failure that can develop late in pregnancy or months after delivery, is one condition that may present with these symptoms.
“Heart failure during and after pregnancy is often hiding in plain sight,” Adedinsewo said. “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 heart failure in the perinatal period include high blood pressure, Type 2 diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology. Among women with known heart disease, heart failure is the most common complication, affecting 11% during pregnancy and postpartum. Significant disparities exist: Black adults have about a 19% higher risk of developing heart failure than white adults, and Black women with PPCM 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.
Delays in diagnosis can be life-threatening. Pregnant women with heart failure are about 32 times more likely to die around delivery compared to those without heart failure. Other risks include stroke, preterm delivery, and poor fetal outcomes. Diagnostic tests such as electrocardiograms (ECG), blood tests for cardiac biomarkers, and echocardiograms can help distinguish between normal pregnancy changes and heart failure.
Treatment involves medications like beta blockers, diuretics, and vasodilators, with a focus on stabilizing maternal heart function and ensuring fetal blood flow. A multidisciplinary cardio-obstetrics team is critical. The postpartum period, especially the first year after delivery, is a high-risk time for heart failure. Continued monitoring, including telemedicine and home visits, is essential. Counseling about contraception is also important; 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,” Adedinsewo said. “Standardized screening, listening carefully to patient concerns and improved access to care are crucial to help improve outcomes for mothers and their families.”
This statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Women’s Health Science Committee and other councils. More information is available at heart.org.
