A new scientific statement from the American Heart Association, published today in Circulation, underscores 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,” highlights that heart failure symptoms—such as shortness of breath, fatigue, and swelling—are frequently dismissed as normal pregnancy discomforts, delaying diagnosis and increasing risks of complications like irregular heartbeat, stroke, and death.
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. Nearly 1 in 4 women aged 20-44 already has some form of cardiovascular disease, as noted in the AHA’s 2026 scientific statement Forecasting the Burden of Cardiovascular Disease and Stroke in Women. The true prevalence of heart failure during pregnancy and postpartum remains unknown, making awareness and vigilance crucial.
“Heart failure during and after pregnancy is often hiding in plain sight,” said Dr. Demilade A. Adedinsewo, chair of the statement writing group and assistant professor at Mayo Clinic. “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.”
Risk factors for perinatal heart failure include pre-existing heart disease, high blood pressure, type 2 diabetes, obesity, older maternal age, multiple gestation, and use of assisted reproductive technology. Among women with known heart disease, heart failure is the most common complication, affecting 11% during pregnancy and postpartum. Significant racial disparities exist: Black adults have a 19% higher risk of developing heart failure than white adults, and Black women with peripartum cardiomyopathy (PPCM) are diagnosed later than other groups. Heart failure contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.
Delayed diagnosis can be life-threatening. Pregnant women with heart failure are about 32 times more likely to die around delivery compared to those without. Other risks for mothers include irregular heartbeat, stroke, preterm delivery, and postpartum hemorrhage. For infants, risks include restricted fetal growth, premature birth, low birth weight, and stillbirth.
The statement emphasizes the importance of diagnostic tests such as electrocardiograms, blood tests for cardiac biomarkers, and echocardiograms to distinguish normal pregnancy changes from heart failure. Treatment may include medications like beta blockers, diuretics, and vasodilators, guided by a multidisciplinary cardio-obstetrics team. The postpartum period—up to one year after delivery—is especially high-risk, requiring continued monitoring through telemedicine, home visits, and remote monitoring technologies.
“Improving postpartum care is essential to protecting maternal health,” said Adedinsewo. “Standardized screening, listening carefully to patient concerns, and improved access to care are crucial to help improve outcomes for mothers and their families.” The statement also recommends long-acting reversible contraceptives, specifically hormonal intrauterine devices, as the preferred contraception for women with heart failure, avoiding estrogen-containing methods due to increased thrombosis risk.
The full statement is available in Circulation at https://www.ahajournals.org/journal/circ. Additional resources from the American Heart Association include information on Pregnancy and Maternal Health and the Life’s Essential 8 metrics for optimal cardiovascular health.
