New Guidance Issued for Managing Pregnant Patients with Heart Failure

A new guidance has been issued by the Society for Maternal-Fetal Medicine (SMFM) to provide recommendations for physicians on counseling and managing patients with heart failure during pregnancy and postpartum. The guidance, outlined in SMFM Consult Series #73, highlights the importance of prepregnancy counseling, assembling multidisciplinary care teams, and referring to centers with expertise to optimize maternal and newborn health outcomes. Heart disease, a leading cause of pregnancy-related deaths in the U.S., is a disproportionate percentage among non-Hispanic Black individuals, and heart failure is a major contributor to maternal morbidity and mortality.

Key Takeaways:

• The SMFM guidelines focus on treating pregnant patients with reduced ejection fraction (HFrEF) heart failure, a condition where the heart is unable to pump blood effectively.
• Symptoms of heart failure, such as shortness of breath and fatigue, can be normal symptoms of pregnancy, making accurate diagnosis and treatment critical.
• The treatment for heart failure in pregnancy depends on which ventricle is impacted, whether it is acute or chronic, and other individual health factors.
• Prepregnancy counseling, multidisciplinary care teams, and referrals to centers with expertise are critical in managing pregnant patients with heart failure.
• Heart disease is a leading cause of pregnancy-related deaths in the U.S., with a disproportionate percentage occurring among non-Hispanic Black individuals.
• Heart failure, a major contributor to maternal morbidity and mortality, increases the risk of low birthweight, lower Apgar scores, premature birth, and death.
• The new SMFM recommendations aim to improve both short- and long-term quality of life for patients with heart disease by providing accurate diagnosis and treatment early in pregnancy.

Statistics:

• Heart disease is a leading cause of pregnancy-related deaths in the U.S.
• 55.1% of pregnancy-related maternal deaths in the U.S. were due to hypertensive disorders, embolism, and other maternal medical conditions (Source: CDC, 2019).
• Non-Hispanic Black individuals have a disproportionate percentage of pregnancy-related deaths, accounting for 34.1% of maternal deaths in the U.S. (Source: CDC, 2019).
• Heart failure is a major contributor to maternal morbidity and mortality, with a significant increase in the risk of low birthweight, lower Apgar scores, premature birth, and death.
• Low ejection fraction (HFrEF) is a common type of heart failure affecting pregnant patients.

Sources:

• (2025) "New Guidance Issued for Managing Pregnant Patients with Heart Failure" by VerticalNews Health
• Centers for Disease Control and Prevention (CDC). (2019). Pregnancy-Related Mortality Surveillance — United States, 2017–2019.