The American Heart Association has released a new scientific statement, “Heart Failure Occurring in the Perinatal Period,” published today in its flagship journal Circulation, highlighting the critical need for early detection and timely treatment of heart failure in pregnant and postpartum women. The statement notes that heart failure symptoms—such as shortness of breath, fatigue, and swelling—are often mistaken for normal pregnancy discomforts, leading to dangerous delays in diagnosis and treatment. This oversight contributes to heart disease becoming one of the leading causes of pregnancy-related death in the U.S.
According to the statement, nearly 1 in 4 women aged 20-44 currently has some form of cardiovascular disease, as detailed in a 2026 American Heart Association scientific statement. The first year after delivery is particularly high-risk, with many women developing heart failure weeks or months postpartum. The writing group, led by Dr. Demilade A. Adedinsewo of the Mayo Clinic, emphasizes that “heart failure during and after pregnancy is often hiding in plain sight,” and that recognizing symptoms earlier could prevent serious complications and save lives.
Risk factors for perinatal heart failure include pre-existing cardiovascular disease, high blood pressure, diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology. Notably, significant racial disparities exist: Black adults have about a 19% higher risk of developing heart failure than white adults, and Black women with peripartum cardiomyopathy (PPCM) are often 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.
Diagnosis requires a high index of suspicion, with tools like electrocardiograms, blood tests for cardiac biomarkers, and echocardiograms used to distinguish heart failure from normal pregnancy changes. Treatment includes medications such as beta blockers, diuretics, and vasodilators that are safe in pregnancy, along with a multidisciplinary cardio-obstetrics team. The statement also stresses the importance of postpartum care beyond the traditional six-week checkup, including home visits, telemedicine, and remote monitoring.
“Improving postpartum care is essential to protecting maternal health,” said Adedinsewo. The statement calls for standardized screening, careful listening to patient concerns, and improved access to care. It also notes that counseling on contraception is important, with hormonal intrauterine devices preferred for women with heart failure, while estrogen-containing methods are not recommended due to thrombosis risk.
The statement was prepared by the American Heart Association’s Women’s Health Science Committee and other councils, and it underscores the urgency of addressing this often-overlooked health crisis to reduce maternal mortality and improve outcomes for mothers and babies.
