Updated Guidelines for Diagnosing and Managing Heart Failure in Pregnancy and Postpartum

The Society for Maternal-Fetal Medicine (SMFM) has released new clinical guidance emphasizing the importance of early diagnosis, comprehensive counseling, and specialized management of heart failure during pregnancy and the postpartum period. Heart disease remains a leading cause of maternal mortality in the United States, particularly affecting non-Hispanic Black populations, with heart failure significantly contributing to maternal complications.

Effective management begins with preconception counseling, where women with known heart failure are assessed for risks and provided tailored advice. For those with severe pulmonary arterial hypertension or notably low ejection fractions (less than 30%), pregnancy continuation may not be advisable, and specialized centers equipped with multidisciplinary Pregnancy Heart Teams are recommended. Women with a history of peripartum cardiomyopathy should receive individualized counseling regarding the risks of recurrence.

Medications play a critical role in treatment; certain drugs like SGLT2 inhibitors, spironolactone, ACE inhibitors, ARBs, and ARNIs should be discontinued before or during pregnancy due to potential fetal risks, with alternatives like hydralazine considered. Beta-blockers such as metoprolol, carvedilol, and bisoprolol are generally safe to continue. Postpartum care necessitates close cardiovascular monitoring because risks of severe complications persist after delivery. Breastfeeding considerations include reviewing medication safety for the infant.

Delivery planning involves assembling a multidisciplinary team to ensure optimal care, with vaginal delivery prioritized unless obstetric indications necessitate cesarean section. Most women with uncomplicated heart failure should aim for delivery at term.

The guidelines underscore the need for ongoing postpartum surveillance to mitigate maternal morbidity and mortality, emphasizing that early detection and management can significantly improve both maternal and neonatal health outcomes.

For more details, consult the SMFM's Series #73 publication in Pregnancy.

Source: https://medicalxpress.com/news/2025-10-guidance-heart-failure-pregnancy-postpartum.html