Heart failure can cause serious complications during pregnancy and in the postpartum period. Having underlying health conditions and a family history may increase the risk of heart failure.

Several health conditions can develop during pregnancy and increase a person’s risk of heart failure.

Other conditions, such as obesity or diabetes, may increase a person’s risk of developing heart failure when pregnant.

With monitoring and successful management, a person may be able to avoid heart failure and other complications.

This article reviews the primary causes of heart failure during pregnancy and includes information on signs and symptoms, diagnosis, and more.

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Heart failure is a serious medical condition. It occurs when a person’s heart does not pump enough blood to meet their body’s requirements. It can also happen when the heart is not strong enough to pump properly.

Heart failure is the most common cardiovascular complication during pregnancy and postpartum. Pregnant people who develop heart failure are at higher risk of death, adverse cardiac events, and poor obstetric outcomes.

A number of conditions can cause heart failure in pregnancy and postpartum. Below are some conditions that can cause heart failure in pregnancy.

Preeclampsia is a serious hypertensive disorder that occurs during pregnancy. Worldwide, it causes 2–8% of all pregnancy-related complications, more than 50,000 maternal deaths, and over 500,000 fetal deaths.

This disorder typically develops after 20 weeks of pregnancy — commonly in the third trimester. It can also develop in the postpartum period.

Developing preeclampsia raises the risk that a person will develop peripartum heart failure.

Signs and symptoms

Signs and symptoms of preeclampsia can vary but often include the following:

  • headaches that are not relieved by medication
  • visual disturbances
  • pain in the upper right abdominal quadrant
  • heartburn-like pain
  • nausea and vomiting
  • shortness of breath
  • increase in swelling
  • sudden weight gain


A doctor will diagnose preeclampsia during pregnancy or postpartum if a person has new onset high blood pressure of 140/90 or higher and either a protein-to-creatinine ratio in their urine of greater than 0.30 or any of the following:

  • abnormal liver or kidney function as shown on blood tests
  • visual disturbances
  • fluid in the lungs and trouble breathing


Scientists are unsure of the exact causes of preeclampsia, but they suspect there may be several factors. Possible causes include:

  • insufficient blood flow to the uterus
  • the way blood vessels form in the placenta
  • excessive inflammatory response to pregnancy
  • calcium and other nutritional deficiencies
  • untreated, undiagnosed high blood pressure before pregnancy
  • preexisting conditions such as lupus, diabetes, and hyperthyroidism
  • imbalance of the hormones that regulate blood vessels
  • genetic factors

Learn more about preeclampsia here.

Peripartum cardiomyopathy (PPCM) is a type of heart failure that occurs in the last month of pregnancy or up to 5 months following delivery. It is not very common, with 1,000–1,300 pregnant or postpartum people in the United States developing the condition each year.

In people with PPCM, the heart’s chambers get bigger while the muscle weakens. This leads to the heart pumping less blood and being unable to keep up with the body’s demands.

Signs and symptoms

The signs and symptoms of PPCM can be similar to symptoms caused by later pregnancy and may include:

The symptoms a person experiences will vary based on what class of PPCM they have. Classes range from 1 to 4, with 1 meaning no symptoms and 4 meaning symptoms while at rest.


Doctors may have difficulty diagnosing PPCM because symptoms can be similar to those of later pregnancy.

If a doctor suspects PPCM, they will do a physical exam to listen for fluid in the lungs and rapid heart rate, and order blood tests and tests that check heart function.

A doctor will diagnose PPCM if the person:

  • develops symptoms in the last month of pregnancy or within 5 months of delivery
  • experiences a reduction in their heart’s pumping ability, with an ejection fraction of less than 45%
  • has no other underlying cause of heart failure


Scientists are not sure of the exact causes of peripartum cardiomyopathy. In some cases, they believe that inflammation from a previous illness or abnormal immune response may cause it.

Other causes may include:

Learn more about PPCM here.

Amniotic fluid embolism (AFE) is a rare, serious pregnancy complication. It occurs in 1 in 8,000 to 1 in 80,000 deliveries. With AFE, a pregnant person has a life threatening reaction to the fetal cells, amniotic fluid, or other pregnancy byproducts that may enter the pulmonary circulation system.

AFE can happen as early as the second trimester but most often occurs during labor, a cesarean section, or shortly after birth. It can cause heart failure and death of the pregnant person and the fetus.

Signs and symptoms

Signs and symptoms of AFE generally occur suddenly and can include:

  • trouble breathing
  • fluid in the lungs
  • low blood pressure
  • problems with blood clotting that lead to bleeding from the uterus, IV site, or surgical incision
  • rapid heart rate
  • sudden heart failure
  • change in the mental state that may include a feeling of impending doom or confusion
  • fetal distress


For a person to be diagnosed with an amniotic fluid embolism, they must meet the following four criteria:

  • sudden low blood pressure or cardiac arrest
  • low levels of oxygen in the blood
  • severe bleeding without other explanation
  • all of the above occurring during labor, surgical delivery, or within 30 minutes of delivery

A doctor will diagnose the condition based on the following:


Scientists do not know what causes AFE. They consider the condition to be unpredictable.

However, some scientists think it may happen due to amniotic fluid or other pregnancy products being forced into the circulation system of the pregnant person and causing a physical blockage.

Others theorize that it may happen after amniotic fluid or other pregnancy products enter the pregnant person’s circulation system and cause an anaphylactic-like reaction.

Learn more about AFE here.

Heart failure during pregnancy may also occur due to the aggravation of preexisting cardiovascular disease.

Possible causes or risk factors for heart failure can include:

A person should contact a doctor if they experience unusual symptoms during pregnancy that could indicate heart problems.

A person should attend their scheduled prenatal visits with a healthcare team. Their doctor may recommend prenatal tests to make sure the developing fetus is healthy. Healthcare professionals will also ask about family history of medical conditions that could affect the pregnancy.

Heart failure is the most common cardiovascular complication during pregnancy. Several conditions can increase the risk of or cause heart failure, including preeclampsia, PPCM, and AFE.

A person should take note of unusual changes in heart rate, increased fatigue, swelling, or other symptoms that may indicate issues with their heart.

A doctor can recommend treatment options based on any underlying conditions to ensure the safety of the pregnant person and fetus.