Heart health in the fourth trimester: maternal health doesn’t end at birth

One of the greatest risks is cardiovascular disease (CVD), a leading cause of maternal mortality. Consider this:

• 80% of pregnancy-related deaths are preventable [1].

• 65% of pregnancy-related deaths occur during the postpartum period in the U.S. [2].

• One in three maternal deaths is attributed to heart disease or stroke [3].

• Hypertension – a common condition in pregnancy – is associated with a 2-4x increased risk of heart disease, stroke and hypertension later in life [4].

Despite this, heart health remains underrecognized in public discussions about caring for a new mother. New moms and caregivers might not realize that heart disease can affect them at all ages and stages of life. They might not know the warning signs that they should look out for, especially as they are busy taking care of a new baby and recovering from childbirth. Conditions like hypertensive disorders, peripartum cardiomyopathy (PPCM), arrhythmias and pregnancy-related blood clots often go undetected and untreated, or they're dismissed as related to stress or anxiety.

We know that awareness, early detection, proper monitoring and comprehensive postpartum care could save countless lives. Yet, many women lack access to adequate medical support during this critical period. It’s time to change that.

One major challenge is that symptoms of cardiovascular complications often mimic common pregnancy and postpartum experiences. Fatigue, swelling and shortness of breath – symptoms frequently dismissed as typical post-birth discomfort – can, in some cases, signal life-threatening conditions.

Dr. Sanjay Gandhi, Global Head of Medical Affairs and Medical Strategy at Philips and a practicing cardiologist, explains:

"During the earlier trimesters, the heart adapts relatively well to increased demands. However, by the third trimester, the strain peaks, increasing the likelihood of conditions such as preeclampsia and peripartum cardiomyopathy. When additional risk factors – such as gestational diabetes or chronic hypertension – are present, the danger is amplified.

"Then comes the fourth trimester, the most overlooked stage. Seven weeks after delivery, as the body undergoes rapid changes – including fluid shifts, hormonal fluctuations and sleep deprivation – many women are at their most vulnerable. Yet ironically, this is when medical care tends to diminish."

For women with preexisting heart conditions, hypertension, diabetes or pregnancy-induced hypertension and preeclampsia, the postpartum period presents even greater risks, including heart failure and life-threatening conditions. However, the healthcare system isn’t set up to provide adequate follow-up care.

Where are the gaps in postpartum care?

For many first-time mothers, their prenatal appointments are their first in-depth interaction with the healthcare system. They go through nine months of increasingly frequent prenatal appointments. Then they give birth, and the care stops. They are discharged from the hospital and told to come back in six weeks for their only postpartum appointment. As many as 40% of women don’t make it into that appointment, and no-show rates are higher among more vulnerable communities like low-income families [5].

Assuming they show up, the traditional six-week postpartum checkup may not be enough for everyone. All women are at risk for postpartum complications, and especially women who had high-risk pregnancies. Postpartum care should ideally include heart screenings, blood pressure monitoring and mental health assessments. Timing matters, too – the standard six-week checkup may be too late for detecting conditions like postpartum cardiomyopathy, which can rapidly worsen after delivery.

The American College of Obstetricians and Gynecologists (ACOG) has suggested since 2016 that we revamp the way we do postpartum care, but there is no payment mechanism for providers offering more postpartum care under the traditional obstetrics payment bundle.

There’s still more to do. As we tackle the unacceptably high rates of maternal mortality in the U.S., I hope that increasing attention is paid to the fourth trimester and that, critically, cardiovascular care must become a standard part of postpartum healthcare. If you agree and have ideas about how to advance this – please reach out!