Statement Highlights:
- Current evidence indicates that nearly 1 in 4 women 20-44 years of age currently has some type of cardiovascular disease, and heart disease is now one of the leading causes of pregnancy-related death in the U.S.
- Heart failure symptoms, such as shortness of breath, fatigue and swelling, often resemble common symptoms experienced during pregnancy and after delivery, which can delay heart failure diagnosis and treatment. This can have life-threatening consequences for both mother and baby.
- The first year after delivery is a high-risk time for women to develop heart failure, and postpartum women need ongoing follow-up care after delivery.
- Standard screening, prompt treatment and coordinated care between obstetricians and heart specialists may help improve maternal health and save lives.
DALLAS, June 24, 2026 — Early detection and timely treatment of heart failure in pregnant or postpartum women are crucial to prevent serious complications, such as irregular heartbeat, stroke and death, according to a new American Heart Association scientific statement, "Heart Failure Occurring in the Perinatal Period."
Heart failure is a serious condition in which the heart cannot pump enough blood well enough to meet the body's needs. The true prevalence of heart failure during pregnancy and the postpartum period is unknown. However, according to a 2026 American Heart Association scientific statement Forecasting the Burden of Cardiovascular Disease and Stroke in Women, nearly 1 in 4 women 20-44 years of age currently have some type of cardiovascular disease. Data from the U.S. Centers for Disease Control and Prevention's Pregnancy Mortality Surveillance System indicates that heart disease is now one of the leading causes of pregnancy-related death in the U.S.
A new scientific statement, published today in the American Heart Association's flagship peer-reviewed scientific journal Circulation, highlights the challenges of recognizing heart failure in pregnant and postpartum women and emphasizes the need for prompt treatment as well as continued monitoring after delivery.
"Heart failure affects more than just the heart—it can affect the lungs, kidneys, brain and more," said Demilade A. Adedinsewo, M.D., M.P.H., chair of the volunteer scientific statement writing group and an assistant professor in the department of cardiovascular medicine at the Mayo Clinic in Jacksonville, Florida. "Because blood flow is reduced and fluid builds up, it can lead to breathing difficulties, kidney issues, irregular heartbeats and increased risk of stroke and death."
What are the symptoms of heart failure during pregnancy and postpartum?
Symptoms of heart failure include shortness of breath, labored breathing, fatigue and weight gain with swelling in the legs and feet. Since these symptoms are also common in otherwise healthy pregnancies, heart failure in women who are pregnant or have recently given birth often goes unrecognized.
Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is a form of heart muscle failure that can develop late in pregnancy or months after delivery. Women who develop PPCM may experience and report various heart failure symptoms due to fluid retention.
"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 Adedinsewo.
What are the risk factors for heart failure?
Heart failure in the perinatal period can affect women who already have cardiovascular disease and those who do not. Risk factors for heart failure in general include high blood pressure, Type 2 diabetes, abnormal cholesterol, overweight/obesity or metabolic syndrome. During the perinatal period, unique risk factors include known heart disease prior to pregnancy, older maternal age, multiple gestation, known genetic variants for heart failure, use of assisted reproductive technology and prolonged use of tocolytic agents (medications used to suppress premature labor). Among women with known heart disease, heart failure is the most common complication, affecting 11% of women during pregnancy and in the postpartum period.
However, significant disparities exist in perinatal heart failure risk and outcomes in the U.S.:
- Black adults have about a 19% higher risk of developing heart failure than white adults.
- Black women and Native American women were more frequently diagnosed with PPCM than white women. Black women with PPCM were also more likely to be diagnosed later compared to other racial groups.
- 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.
What are the risks if heart failure is not diagnosed and treated promptly?
Heart failure poses substantial risks to the health of a mother and baby. Delays in recognizing and diagnosing heart failure during the perinatal period can be life-threatening. Data from a national database found that 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 who do not have heart failure.
Other risks for the mother include irregular heartbeat, stroke, worsening cardiac function, preterm delivery, caesarean delivery, postpartum hemorrhage, poor mental health and poor quality of life. Heart failure in the mother during pregnancy increases the risk of restricted fetal growth, premature birth, low birth weight, a prolonged stay in the pediatric intensive care unit, stillbirth or death in the first four weeks of an infant's life.
How is heart failure diagnosed in pregnant and postpartum women?
Knowing the signs and symptoms of heart failure, as well as prompt medical evaluation and testing, are crucial first steps in improving women's health. The statement emphasizes that it is important for clinicians to evaluate patients with any heart symptoms during pregnancy, particularly if they have other cardiovascular risk factors.
Diagnostic testing, such as electrocardiograms (ECG), blood tests for cardiac biomarkers and echocardiograms, can help clinicians distinguish between normal pregnancy changes and warning signs of heart failure.
How is heart failure managed during pregnancy?
Although there is no cure for heart failure, it can be managed with medications and healthy lifestyle. Many women with new onset of heart failure in the perinatal period recover heart function with appropriate care. Treatment is guided by the severity of the disease. Medications to treat heart failure that may be considered safe in pregnancy include beta blockers, diuretics, vasodilators and anticoagulants (when appropriate). The priorities are to stabilize maternal heart function and ensure the fetus is receiving adequate blood flow. A multidisciplinary cardio-obstetrics team to provide continuous monitoring and treatment is critical for optimal care.
Achieving optimal cardiovascular health, as outlined by the American Heart Association's Life's Essential 8 metrics, is increasingly recognized as important before, during and after pregnancy. People with heart failure who follow a healthy eating plan, engage in regular physical activity and get support from family and friends often report greater improvement in managing symptoms and emotional well-being.
Why is the postpartum period critical?
The postpartum period, which extends through the first year after delivery, is a particularly high-risk time for women to develop heart failure. Some women first experience symptoms within the first few days after childbirth, while others develop symptoms weeks or months after delivery. Referrals from obstetric care/maternal-fetal medicine specialists to other health care professionals, whether cardiology or primary care, are an essential component of high-quality postpartum care beyond the traditional 6-week postpartum period. Continued monitoring during the first year after delivery may include home visits and alternatives to in-person appointments, such as telemedicine and using digital technologies for remote monitoring and symptom assessments.
Counseling about contraception is also an important consideration for postpartum women. Long-acting reversible contraceptives (LARCs), specifically hormonal intrauterine devices, are the preferred method of contraception for women with cardiovascular disease including heart failure. Estrogen-containing methods are not recommended for women with moderate or severe heart failure due to the increased risk for thrombosis (blood clots in the veins and arteries).
"Improving postpartum care is essential to protecting maternal health. Standardized screening, listening carefully to patient concerns and improved access to care are crucial to help improve outcomes for mothers and their families," said Adedinsewo.
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association's Women's Health Science Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Surgery and Anesthesia, and the Council on Cardiovascular and Stroke Nursing. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association's official clinical practice recommendations.
Co-authors are Vice Chair Nosheen Reza, M.D, M.S., Haywood L. Brown, M.D.; Afshan B. Hameed, M.D., M.B.A..; Dennis McNamara, M.D.; Mulubrhan F. Mogos, Ph.D., M.Sc., FAHA; Jenna Skowronski, M.D.; Arthur Vaught, M.D; Marie-Louise Meng, M.D.; and Modele O. Ogunniyi, M.D., M.P.H., FAHA. Authors' disclosures are listed in the manuscript.
