New Guidance to Improve Diagnosis and Management of Heart Failure During Pregnancy and Postpartum

Heart disease remains the leading cause of pregnancy-related deaths in the United States, with heart failure accounting for a large share of maternal morbidity and mortality. The condition, characterized by the heart’s inability to pump blood effectively, can lead to serious complications for both mother and baby, including preterm birth, low birth weight, and even death. Recognizing these risks, experts have now issued new recommendations aimed at improving diagnosis, treatment, and postpartum management of heart failure in pregnant patients.

The Society for Maternal-Fetal Medicine (SMFM, Washington, DC, USA) has released Consult Series #73, a comprehensive set of guidelines for diagnosing and managing right and left heart failure during pregnancy and after childbirth. The guidance emphasizes early risk assessment, preconception counseling, and coordinated care through multidisciplinary teams. It also highlights the importance of referring high-risk patients to specialized centers with Pregnancy Heart Teams to ensure optimal maternal and newborn outcomes.

The recommendations address the complexities of managing heart failure in pregnancy, particularly for patients with reduced ejection fraction (HFrEF). Since symptoms like shortness of breath and fatigue can overlap with normal pregnancy changes, accurate diagnosis is critical. The guidance also includes medication safety updates, advising that drugs such as ACE inhibitors, ARBs, and SGLT2 inhibitors be discontinued during pregnancy and substituted with safer alternatives like hydralazine. Beta-blockers such as metoprolol, carvedilol, and bisoprolol, however, should be continued.

In terms of delivery planning, the report recommends early coordination between obstetric, cardiology, anesthesia, and nursing teams. Most uncomplicated patients should aim for a term vaginal delivery unless a cesarean is medically required for obstetric indications. Postpartum care is equally vital, as many cardiovascular complications arise after hospital discharge. Close monitoring, breastfeeding safety reviews, and medication compatibility checks are advised to ensure both maternal and infant well-being.

The new guidance, published in Pregnancy, underscores that individualized care and early intervention can drastically improve outcomes for pregnant individuals with cardiovascular disease. By standardizing protocols across healthcare settings, SMFM aims to reduce disparities in maternal health—particularly among non-Hispanic Black women, who experience disproportionate rates of cardiac complications during pregnancy.

“Heart disease is a leading cause of maternal deaths, and it’s a growing problem,” said Arthur Jason Vaught, MD, a maternal-fetal medicine subspecialist and critical care physician at Johns Hopkins Medicine, and a member of the SMFM Publications Committee. “This new guidance focuses attention on heart failure in pregnancy so that we can improve both short- and long-term quality of life for our patients. Getting accurately diagnosed and treated for heart disease, either before pregnancy or early in pregnancy, is both life-prolonging and life-changing if caught early.”

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