A new scientific statement from the American Heart Association, published today in Circulation, emphasizes the critical need for early detection and treatment of heart failure in pregnant and postpartum women. The statement, “Heart Failure Occurring in the Perinatal Period,” underscores that symptoms such as shortness of breath, fatigue, and swelling are often mistaken for normal pregnancy changes, leading to delayed diagnosis and life-threatening complications.
Heart failure affects the heart's ability to pump blood, leading to fluid buildup and potential damage to the lungs, kidneys, and brain. 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., per CDC data. The first year after delivery is particularly risky, with some women developing heart failure weeks or months postpartum.
Risk factors include pre-existing heart disease, high blood pressure, diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology. Disparities are significant: Black adults have a 19% higher risk of developing heart failure than white adults, and Black women with peripartum cardiomyopathy are often diagnosed later. Heart failure contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.
“Heart failure during and after pregnancy is often hiding in plain sight. 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,” said Demilade A. Adedinsewo, M.D., M.P.H., chair of the writing group.
Diagnosis involves ECGs, blood tests for cardiac biomarkers, and echocardiograms. Treatment includes medications like beta blockers, diuretics, and vasodilators, with a multidisciplinary cardio-obstetrics team crucial for monitoring. The postpartum period requires continued care beyond six weeks, including telemedicine and home visits. Contraception counseling is also important; long-acting reversible contraceptives like hormonal IUDs are preferred, while estrogen-containing methods are not recommended for moderate to severe heart failure due to thrombosis risk.
The statement calls for standardized screening, careful listening to patient concerns, and improved access to care. “Improving postpartum care is essential to protecting maternal health,” Adedinsewo added.
Additional resources from the American Heart Association include a February 2026 statement on cardiovascular disease projections and an October 2025 release on postpartum CVD risk.
