Heart Failure in Pregnancy: New Statement Highlights Urgent Need for Awareness and Early Detection

A new scientific statement from the American Heart Association, published today in Circulation, highlights the critical need for early detection and treatment of heart failure during and after pregnancy. Heart failure, a condition where the heart cannot pump enough blood to meet the body's needs, often presents with symptoms such as shortness of breath, fatigue, and swelling—common in healthy pregnancies, leading to delayed diagnosis and life-threatening complications for both mother and baby.

According to the statement, nearly 1 in 4 women aged 20-44 currently has some form of cardiovascular disease, and heart disease is a leading cause of pregnancy-related death in the U.S. The first year after delivery is particularly high-risk, yet postpartum care often ends after six weeks, missing a crucial window for intervention. "Heart failure during and after pregnancy is often hiding in plain sight," said Dr. Demilade A. Adedinsewo, chair of the writing group. "By recognizing symptoms earlier and initiating appropriate treatment, clinicians have a powerful opportunity to save lives."

Risk factors include pre-existing heart disease, high blood pressure, diabetes, obesity, older maternal age, and multiple gestation. Significant racial disparities exist: Black women have a 19% higher risk of developing heart failure than white women, and Black and Native American women are more frequently diagnosed with peripartum cardiomyopathy (PPCM), a form of heart failure that develops late in pregnancy or postpartum. Heart failure or abnormal cardiac function contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.

Diagnosis requires prompt evaluation with electrocardiograms, blood tests, and echocardiograms to distinguish normal pregnancy changes from heart failure. Treatment includes medications such as beta-blockers and diuretics, along with a multidisciplinary cardio-obstetrics team. The statement stresses the importance of continued monitoring during the first year after delivery, including telemedicine and remote monitoring. Contraception counseling is also vital, with hormonal intrauterine devices preferred for women with heart failure, while estrogen-containing methods are not recommended due to thrombosis risk.

The statement calls for standardized screening and improved access to care to address disparities and reduce maternal mortality. "Improving postpartum care is essential to protecting maternal health," Adedinsewo added. The full statement is available online at Circulation.