The American Heart Association has released a new scientific statement, “Heart Failure Occurring in the Perinatal Period,” highlighting the critical need for early detection and timely treatment of heart failure in pregnant and postpartum women. The statement, published today in the journal Circulation, underscores that heart failure symptoms such as shortness of breath, fatigue, and swelling are often mistaken for normal pregnancy changes, leading to delayed diagnosis and potentially life-threatening consequences for both mother and baby.
Heart failure affects nearly 1 in 4 women aged 20-44 in the U.S., according to a 2026 American Heart Association scientific statement Forecasting the Burden of Cardiovascular Disease and Stroke in Women. 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 during and after pregnancy is often hiding in plain sight,” said Demilade A. Adedinsewo, M.D., M.P.H., chair of the volunteer scientific statement writing group and an assistant professor in the department of cardiovascular medicine 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.”
The statement highlights that the first year after delivery is a particularly high-risk time for women to develop heart failure. Women who experience symptoms such as labored breathing, fatigue, and swelling in the legs and feet may dismiss these as normal postpartum changes. However, these could be signs of peripartum cardiomyopathy (PPCM), a form of heart muscle failure that can develop late in pregnancy or months after delivery.
Risk factors for heart failure during the perinatal period include pre-existing cardiovascular disease, 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 with PPCM are more likely to be diagnosed later than other racial groups. Heart failure contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.
If left undiagnosed and untreated, heart failure poses substantial risks. Pregnant women with heart failure are about 32 times more likely to die around the time of delivery compared to those without heart failure. Other risks include irregular heartbeat, stroke, preterm delivery, and poor outcomes for the baby, such as restricted fetal growth and stillbirth.
Diagnosis involves electrocardiograms (ECG), blood tests for cardiac biomarkers, and echocardiograms to distinguish between normal pregnancy changes and heart failure. Treatment with medications such as beta blockers, diuretics, and vasodilators can be safe during pregnancy, and a multidisciplinary cardio-obstetrics team is critical for optimal care.
The statement emphasizes that postpartum care should extend beyond the traditional six-week period, with continued monitoring, telemedicine, and remote symptom assessments. Contraception counseling is also important: long-acting reversible contraceptives (LARCs) are preferred for women with cardiovascular disease, 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.”
