DALLAS — Early detection and timely treatment of heart failure in pregnant or postpartum women are crucial to prevent serious complications such as irregular heartbeat, stroke and death, according to a new American Heart Association scientific statement, “Heart Failure Occurring in the Perinatal Period,” published today in the journal Circulation.
Heart failure, a condition where the heart cannot pump enough blood to meet the body’s needs, is a growing concern among women of childbearing age. The statement notes that nearly 1 in 4 women aged 20-44 currently have some type of cardiovascular disease, and heart disease is now one of the leading causes of pregnancy-related death in the United States, according to data from the U.S. Centers for Disease Control and Prevention’s Pregnancy Mortality Surveillance System.
“Heart failure during and after pregnancy is often hiding in plain sight,” said Dr. Demilade A. Adedinsewo, chair of the statement 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.”
Symptoms such as shortness of breath, fatigue and swelling are common in healthy pregnancies, making heart failure difficult to distinguish. This delay in diagnosis can be fatal. Data cited in the statement show 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 poses risks to both mother and baby, including irregular heartbeat, stroke, preterm delivery, and for the infant, restricted fetal growth, premature birth, and stillbirth. The postpartum period, especially the first year after delivery, is a particularly high-risk time for developing heart failure.
Disparities in outcomes are significant. Black adults have about a 19% higher risk of developing heart failure than white adults. Black women and Native American women are more frequently diagnosed with peripartum cardiomyopathy (PPCM), a form of heart failure that develops late in pregnancy or after delivery. Black women with PPCM are also more likely to be diagnosed later than other groups. Heart failure contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.
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. The statement emphasizes that standard screening, prompt diagnostic testing (such as ECG, blood tests, and echocardiograms), and coordinated care between obstetricians and cardiologists are essential.
Treatment may include medications like beta blockers and diuretics that are safe during pregnancy, and a multidisciplinary cardio-obstetrics team is critical. Achieving optimal cardiovascular health as outlined by the American Heart Association’s Life’s Essential 8 metrics is increasingly recognized as important before, during, and after pregnancy.
“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.” The statement also highlights the importance of contraception counseling, noting that long-acting reversible contraceptives are preferred for women with heart failure.
