Heart Failure in Pregnant and Postpartum Women Often Overlooked, New Scientific Statement Warns

A new scientific statement from the American Heart Association emphasizes the importance of early recognition and treatment of heart failure in pregnant and postpartum women, a condition that often goes undiagnosed because its symptoms—shortness of breath, fatigue, and swelling—resemble common pregnancy discomforts. The statement, published today in the Association’s journal Circulation, notes that heart disease is now one of the leading causes of pregnancy-related death in the U.S., according to data from the CDC’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.”

The statement highlights that nearly 1 in 4 women aged 20-44 currently has some type of cardiovascular disease, based on a 2026 American Heart Association scientific statement Forecasting the Burden of Cardiovascular Disease and Stroke in Women. Heart failure can affect women with or without pre-existing heart conditions, and risk factors include high blood pressure, diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology.

Disparities are significant: Black adults have about a 19% higher risk of developing heart failure than white adults, and Black women and Native American women are more frequently diagnosed with peripartum cardiomyopathy (PPCM), a form of heart failure that occurs late in pregnancy or after delivery. Heart failure contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.

The consequences of delayed diagnosis can be dire. Women who are pregnant and have heart failure are about 32 times more likely to die around the time of delivery compared to pregnant women without heart failure. Other risks include irregular heartbeat, stroke, preterm delivery, and poor fetal outcomes such as low birth weight and stillbirth.

The statement stresses that the first year after delivery is a particularly high-risk time for developing heart failure. It recommends standardized screening, prompt diagnostic testing such as electrocardiograms and echocardiograms, and coordinated care between obstetricians and heart specialists through a multidisciplinary cardio-obstetrics team. Medications considered safe in pregnancy, including beta blockers and diuretics, can help manage the condition.

“Improving postpartum care is essential to protecting maternal health,” said Adedinsewo. Continued monitoring beyond the traditional six-week postpartum visit, including telemedicine and remote monitoring, is crucial. The statement also advises counseling on contraception, noting that long-acting reversible contraceptives like hormonal intrauterine devices are preferred for women with heart failure, while estrogen-containing methods are not recommended due to increased thrombosis risk.

The American Heart Association’s Advancing Maternal Health Initiative aims to address these issues, and the Association’s Life’s Essential 8 metrics—including healthy eating, physical activity, and social support—are increasingly recognized as important before, during, and after pregnancy.

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