Opportunities in the postpartum period to reduce cardiovascular disease risk after adverse pregnancy outcomes: a scientific statement from the American Heart Association
Open accessAbstract
Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life’s Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.
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GLP-1-based therapy often causes significant weight loss and improvements in CKM risk profiles and MASLD, while SGLT2i has a marked impact on CKD.
“GLP-1–based therapy often causes significant weight loss and improvements in CKM risk profiles and MASLD, while SGLT2i has a marked impact on CKD.19–30”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The Postpartum Weight Management Interventions section says weight-loss interventions may include GLP-1 receptor agonists for eligible patients. It does not report that GLP-1 therapy often causes significant weight loss or improves CKM risk profiles or MASLD. The passages on CKD discuss postpartum kidney risk and monitoring, not an effect of SGLT2 inhibitors. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn some population subgroups, such as Asian Americans, a BMI cut-off of ≥23 kg/m2 is suggested for overweight due to increased metabolic risk at relatively low levels of weight.
“In some population subgroups, such as Asian Americans, a BMI cut-off of ≥23 kg/m2 is suggested for overweight due to increased metabolic risk at relatively low levels of weight.27,28”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The Postpartum Weight Management Interventions section discusses obesity and postpartum cardiovascular risk, but does not give an ethnicity-specific BMI threshold. Searches for Asian Americans, BMI ≥23 kg/m², and lower metabolic-risk thresholds found no passage in our copy addressing the claimed cutoff. (LLM, conf=0.73)
Experimental — accuracy not yet measuredMany published qualitative systematic reviews and meta-analyses exist on self-directed digital health interventions.
“There are, however, many published qualitative systematic reviews and meta-analyses on this topic.25–29”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The Postpartum Weight Management Interventions and Postpartum Interventions Targeted to Populations With HDP sections discuss digital interventions and individual trials, but do not say that many qualitative systematic reviews or meta-analyses exist on self-directed digital health interventions. Searches for those terms found systematic reviews in the References on other topics, not support for this claim. The retrieved passages provide no page number. (LLM, conf=0.75)
Experimental — accuracy not yet measuredStudies examining the cost-effectiveness of adding SGLT2i to prior standard care in patients with diabetes found that, from a US health care sector perspective, this approach is projected to be cost-effective compared with standard therapy.
“Studies examining the cost-effectiveness of adding SGLT2i to prior standard care in patients with diabetes found that, from a US health care sector perspective, this approach is projected to be cost-effective compared with standard therapy.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The Blood Glucose Monitoring and Postpartum Weight Management Interventions sections discuss diabetes screening and lifestyle interventions, not the cost-effectiveness of adding SGLT2 inhibitors to standard care. Searches for SGLT2 inhibitors and US health care sector cost-effectiveness found no passage addressing the claim; page numbers were unavailable in our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measuredA modeling study among those with diabetic kidney disease (DKD) found that adding empaglifozin to the standard of care is projected to be cost-effective relative to the standard of care alone from a US health care sector perspective.
“A modeling study among those with diabetic kidney disease (DKD) found that adding empaglifozin to the standard of care is projected to be cost-effective relative to the standard of care alone from a US health care sector perspective.28”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The BP Trajectory section (page not supplied) discusses CKD risk after preeclampsia, while the Postpartum Weight Management Interventions section discusses lifestyle interventions after gestational diabetes. Searches for empagliflozin, diabetic kidney disease, cost-effectiveness, and a US health care sector modeling perspective found no passage addressing the claimed projection. (LLM, conf=0.75)
Experimental — accuracy not yet measured
While these trials did not recruit patients with pre-HF or analyze this subgroup, post-hoc biomarker substudies of these trials suggested a high median NT-proBNP and hs-cTn, with >50% of the trial population demonstrating biomarker levels consistent with pre-HF.
“While these trials did not recruit patients with pre-HF or analyze this subgroup, post-hoc biomarker substudies of these trials suggested a high median NT-proBNP and hs-cTn, with >50% of the trial population demonstrating biomarker levels consistent with pre-HF.27–30”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe absolute risk of cardiovascular and noncardiovascular perioperative complications after MBS is significantly higher in patients with versus without ASCVD.
“However, the absolute risk of cardiovascular and noncardiovascular perioperative complications after MBS is significantly higher in patients with versus without ASCVD.27,28”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The Postpartum Weight Management Interventions section mentions bariatric surgery only as a possible weight-loss intervention for eligible patients (page unavailable). Searches for MBS, perioperative complications, and outcomes in patients with versus without ASCVD found no passage addressing the claimed comparison. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe safety of MBS in HFrEF is undefined.
“The safety of MBS in HFrEF is also undefined.28”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The Postpartum Weight Management Interventions section mentions bariatric surgery as a possible weight-loss option for eligible patients, but does not discuss its safety in HFrEF. Searches for MBS, HFrEF, reduced ejection fraction, and surgical safety found no passage addressing the claim in our copy; no page number was provided. (LLM, conf=0.76)
Experimental — accuracy not yet measuredA U-shaped curve is observed for mortality among patients with T2D and existing HF, highlighting potential harm from very aggressively targeting glycemia in this population.
“However, a U-shaped curve is observed for mortality among patients with T2D and existing HF,26–28 highlighting the potential harm associated with very aggressively targeting glycemia in this population.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The Blood Glucose Monitoring section discusses postpartum screening after gestational diabetes, not mortality in patients with type 2 diabetes and existing heart failure. Searches for a U-shaped mortality relationship and intensive glucose lowering in that population found no passage addressing the claim; page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredChanges in kidney function were not routinely evaluated in the initial studies of ACEi and ARB for HF, and patients with creatinine >2.5 mg/dL were usually excluded.
“Changes in kidney function were not routinely evaluated in the initial studies of ACEi and ARB for HF, and patients with creatinine >2.5 mg/dL were usually excluded.28”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The BP Trajectory section discusses postpartum renal-function assessment, and the management table discusses creatinine testing after pregnancy; neither addresses early ACE inhibitor or ARB trials for heart failure. Searches for kidney-function evaluation in those trials and the 2.5 mg/dL creatinine exclusion threshold found no supporting passage in our copy. Page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measuredAmong patients with HFrEF, RASi improves both HF outcomes and risk for worsening kidney disease in several clinical trials.
“Among patients with HFrEF, RASi improves both HF outcomes and risk for worsening kidney disease in several clinical trials.1–8,28”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The BP Monitoring and Pharmacotherapy section says enalapril can be used safely during lactation, and the BP Trajectory section discusses postpartum kidney risk. Neither reports clinical trials showing that RAS inhibitors improve heart-failure outcomes and reduce worsening kidney disease in patients with HFrEF. Searches for HFrEF, RAS inhibitors, and renal outcomes found no passage addressing that claim; page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredData from meta-analyses and pooled studies demonstrate that individuals at highest risk for MASLD and its progression include those with T2D and/or those with more than 2 cardiometabolic risk factors such as obesity, hyperlipidemia, or hypertension.
“Data from meta-analyses and pooled studies demonstrate that individuals at highest risk for MASLD and its progression include those with T2D and/or those with more than 2 cardiometabolic risk factors such as obesity, hyperlipidemia, or hypertension.14,28–30”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [28]
The Postpartum Weight Management Interventions and Blood Lipids sections discuss obesity and dyslipidemia as cardiovascular risk factors, not as predictors of MASLD. Searches for MASLD, fatty liver disease, liver progression, and the threshold of more than two cardiometabolic risk factors found no passage in our copy addressing the claim; the available passages have no page numbers. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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References 122 · Cited by 229
- Authors
- Lewey, J., Beckie, T. M., Brown, H. L., Brown, S. D., Garovic, V. D., Khan, S. S., Miller, E. C., Sharma, G., Mehta, L. S., & on behalf of the American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology; Council on Cardiopulmonary, C. C.
- ORCID
- Venue
- Circulation
- Published
- 2024-02-13
- Volume
- 149
- Issue
- 7
- Pages
- e330-e346
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC11185178
- OpenAlex
- W4391743282
- Semantic Scholar
- 2a7d5857e8b67f741ed5b9ba7031840b5645d20e
- Cited by
- 229
- References
- 122
- Citations by year
- 2026: 124 · 2025: 79 · 2024: 25 · 2020: 1
- FWCI
- 21.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (KL2TR003099, UG3OD035540)
- National Institute on Aging (R21AG069111)
- National Heart, Lung, and Blood Institute (R01HL142996, K23HL153667)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK118455, P30DK092924, K26DK138246, R01DK122087)
- National Institute of Neurological Disorders and Stroke (K23NS107645, R01NS122815)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD110992)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Issues in Pregnancy
- Keywords
- adverse pregnancy outcomes, postpartum period, cardiovascular risk, fourth trimester, blood pressure control, lifestyle intervention, Life's Essential 8, cardiovascular disease prevention
- MeSH terms
- American Heart Association, Blood Pressure, Cardiovascular Diseases, Female, Humans, Pregnancy, Pregnancy Outcome, Risk Factors, United States, Postpartum Period
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