SMFM Releases New Guidelines for Managing Heart Failure in Pregnancy and Postpartum - Video

The Society for Maternal-Fetal Medicine (SMFM) has issued new clinical guidance in its Consult Series #73, published in the American Journal of Obstetrics & Gynecology, focused on the diagnosis and management of right and left heart failure during pregnancy and postpartum. The guidance emphasizes the importance of prepregnancy counseling, multidisciplinary care teams, and referrals to specialized centers to improve maternal and newborn outcomes.

Heart disease remains a leading cause of pregnancy-related mortality in the United States, with heart failure significantly contributing to maternal deaths and complications. The burden is disproportionately high among non-Hispanic Black individuals. Heart failure, characterized by the heart's inability to effectively pump blood, can also raise the risk of premature birth, low birth weight, low Apgar scores, and maternal death.

The SMFM recommendations focus on managing heart failure with reduced ejection fraction (HFrEF) during pregnancy, a condition in which distinguishing symptoms, like shortness of breath and fatigue, may be mistaken for normal pregnancy changes. The guidance outlines specific management based on whether the heart's left, right, or both ventricles are affected, and whether the condition is acute or chronic.

The guidelines advise discontinuing several medications that may harm fetal development, including ACE inhibitors, ARBs, SGLT2 inhibitors, and ARNi, while encouraging the continuation of beta-blockers like metoprolol and carvedilol. Delivery should generally occur at term with vaginal birth preferred unless there are obstetric indications for cesarean. Postpartum care is also highlighted, noting the risk of cardiovascular deterioration after discharge, with recommendations for close monitoring and medication review for breastfeeding safety.

“Heart disease is a leading cause of maternal deaths, and it’s a growing problem,” said Dr. Arthur Jason Vaught, maternal-fetal medicine specialist at Johns Hopkins Medicine and 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.”

Reference: Society for Maternal-Fetal Medicine (SMFM), Hameed, A.B., Licon, E., Vaught, A.J., Shree, R. and SMFM Publications Committee (2025), Society for Maternal-Fetal Medicine Consult Series #73: Diagnosis and management of right and left heart failure during pregnancy and postpartum. Pregnancy, 1: e70059. https://doi.org/10.1002/pmf2.70059