AHA Statement Highlights Underrecognized Perinatal Heart Failure

Key Takeaways

• In pregnant and postpartum individuals, the AHA statement described perinatal HF as an underrecognized cardio-obstetric syndrome that includes both preexisting and acute presentations.
• Recent literature cited by the statement estimated a measurable overall burden of perinatal HF, with a higher reported burden among Black women.
• Adedinsewo said the true burden remains uncertain because definitions have changed over time, recognition and diagnosis are difficult, and routine screening is lacking.
• Black and Native American women were reported to have higher rates of peripartum cardiomyopathy, maternal morbidity, and mortality than white women, and Black women were described as being diagnosed later with poorer outcomes.
• Delayed recognition and treatment were linked to worsening HF, abnormal heart rhythms, stroke, need for intensive care, and death.

Dyspnea, edema, and other cardiac symptoms during pregnancy or after delivery can resemble routine peripartum change even when heart failure (HF) is emerging. That overlap can blunt diagnostic suspicion and delay evaluation, especially when previously unrecognized cardiac disease first becomes apparent around pregnancy. In that setting, clearer definitions of perinatal HF have become central to cardio-obstetric care, a gap Adedinsewo and colleagues addressed in Circulation.

Adedinsewo and colleagues authored an American Heart Association (AHA) scientific statement in Circulation on heart failure during pregnancy and the postpartum period on behalf of the AHA 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. The statement defines HF during pregnancy and the postpartum period and addresses screening and management of preexisting and acute perinatal HF, with the available summary presenting the authors’ synthesis of evidence and knowledge gaps.

In Adedinsewo’s discussion of prevalence estimates and recognition gaps in perinatal heart failure, recent literature estimates placed perinatal HF at 1 in 951 overall and as high as 1 in 326 among Black women. Adedinsewo said the true incidence and prevalence remain uncertain because definitions have changed over time, recognition and diagnosis are difficult, and routine screening is lacking. The statement also described perinatal HF as affecting patients with existing heart disease, those with HF risk factors, those with previously undiagnosed heart conditions, and some women previously thought to be healthy.

The statement also described higher rates of peripartum cardiomyopathy, maternal morbidity, and mortality among Black and Native American women than among white women, with Black women reported to be diagnosed later and to have poorer outcomes. Maternal mortality from perinatal HF was described as highest in Africa and the Asia/Pacific area. For earlier recognition, the authors outlined a framework built around structured risk assessment, careful symptom evaluation, echocardiography, cardiac biomarkers, and early referral. Delayed recognition and treatment were linked to worsening HF, abnormal heart rhythms, stroke, need for intensive care, and death.

Across pregnancy and the postpartum period, perinatal HF emerged as a syndrome that can hide behind common symptoms, falls unevenly across populations, and carries severe maternal consequences when recognition is delayed. Adedinsewo and coauthors identified better definitions, surveillance, improved access to care, multidisciplinary cardio-obstetric care, patient education, clinician awareness, inclusion of pregnant and postpartum individuals in cardiovascular (CV) research, and future evidence generation including the REBIRTH trial as ongoing priorities.

Clinician Questions

Which patients were described as being at risk for perinatal heart failure?

The statement described perinatal HF as clinically relevant even in women who were previously healthy before pregnancy, while also identifying higher risk among those with preexisting heart disease, HF risk factors, or previously undiagnosed heart conditions.

How did the statement authors describe early evaluation for suspected perinatal heart failure?

The authors framed early evaluation as a structured assessment when cardiac symptoms arise during pregnancy or postpartum, using symptom review, risk assessment, echocardiography, cardiac biomarkers, and early referral within a descriptive evidence-based framework.

What makes the true burden of perinatal heart failure hard to measure?

Adedinsewo attributed the uncertainty to shifting definitions over time, difficulty recognizing and diagnosing the condition, and the absence of routine screening, which together suggest that perinatal HF is underrecognized and underreported.