Understanding Cardiovascular Disease in Pregnancy and Postpartum Care
Published Jul 9, 2026
Cardiovascular disease remains one of the leading causes of pregnancy-related death in Missouri and across the United States. While many people associate pregnancy complications with labor and delivery, some of the greatest risks occur after a patient leaves the hospital.
According to Karen L. Florio, D.O., MPH, maternal-fetal medicine specialist at the University of Missouri and director of cardio-obstetrics, improving maternal cardiovascular outcomes requires health care teams to look beyond pregnancy as a single event and instead view it as part of a woman’s lifelong health journey.
“Pregnancy should not be viewed as an isolated event, but rather as one chapter in a woman’s overall cardiovascular health journey,” Florio said.
Understanding the Growing Need
Maternal cardiovascular disease continues to be a major contributor to pregnancy-related mortality. At the same time, the population entering pregnancy is changing. More women are becoming pregnant later in life and with chronic health conditions such as hypertension, diabetes and obesity that can increase cardiovascular risk.
These trends highlight the need for a lifespan approach to maternal health that begins before conception and extends well beyond delivery.
“Improving maternal cardiovascular outcomes requires a focus on preconception health, pregnancy and postpartum care,” Florio said. “We must help women optimize chronic medical conditions before pregnancy and ensure they have access to effective contraception until they are ready to conceive.”
The burden of cardiovascular disease is not felt equally. Black women continue to experience disproportionately higher rates of both cardiovascular disease and maternal mortality, underscoring the need for fair access to high-quality care and early risk identification.
Pregnancy Places Unique Demands on the Heart
Pregnancy requires significant physiologic adaptation. Blood volume increases by approximately 40%-50%, cardiac output rises by as much as 50% and heart rate increases while blood vessel resistance decreases. These changes support fetal growth but also can reveal previously undiagnosed heart conditions or worsen existing disease.
Labor, delivery and the postpartum period place additional stress on the cardiovascular system through pain, fluid shifts, blood loss and dramatic changes in circulation after birth.
For healthy patients, these changes are generally well tolerated. For those with underlying cardiovascular disease, hypertension, cardiomyopathy, pulmonary hypertension, congenital heart disease or aortic conditions, however, the risk of serious complications increases significantly.
Understanding the difference between normal physiologic changes and warning signs of disease is critical for every member of the health care team.
Cardio-Obstetrics: A Team Sport
The growing field of cardio-obstetrics recognizes that no single provider can address maternal cardiovascular health alone.
“Medicine cannot be practiced in silos,” Florio said.
Caring for pregnant and postpartum patients with cardiovascular conditions requires collaboration among obstetricians, maternal-fetal medicine specialists, cardiologists, primary care physicians, family medicine providers, emergency medicine physicians, anesthesiologists, nurses, pharmacists and other health care professionals.
Because each specialty approaches patient care through a different lens, providers must actively work to understand one another’s expertise and the unique physiologic considerations of pregnancy and postpartum care.
This collaboration should begin before pregnancy and continue long after delivery. Every health care encounter presents an opportunity to discuss reproductive goals, pregnancy intentions and contraceptive needs, helping patients enter pregnancy as healthy as possible.
Why the Postpartum Period Matters
Many pregnancy-related cardiovascular deaths occur after delivery, making the postpartum period one of the most vulnerable times for patients with cardiovascular disease.
Following birth, dramatic shifts in blood volume, cardiac output and fluid balance can trigger or worsen cardiovascular conditions. Patients remain at risk for hypertensive disorders, heart failure, arrhythmias, thromboembolic events and other cardiovascular emergencies long after discharge.
One challenge is that symptoms such as shortness of breath, chest pain, severe headaches, fainting or worsening swelling can sometimes be dismissed as part of normal postpartum recovery.
“Symptoms should never be automatically attributed to normal postpartum recovery,” Florio emphasized.
Health care providers across all settings — not just obstetrics — play a critical role in recognizing warning signs and ensuring timely evaluation and treatment.
Equally important is ensuring smooth transitions between obstetric care and long-term medical care. Pregnancy complications such as preeclampsia, gestational hypertension, gestational diabetes and preterm birth can serve as early indicators of future cardiovascular disease risk.
Warm handoffs between obstetric providers, primary care physicians, cardiologists and other specialists can help improve both immediate maternal outcomes and long-term cardiovascular health.
Advancing Knowledge Through Research
Florio also serves as co-principal investigator of the Heart Outcomes in Pregnancy Expectations (HOPE) Study, one of the largest prospective studies examining cardiovascular disease during pregnancy and the postpartum period.
The NIH-funded study is enrolling pregnant individuals with a broad range of cardiovascular conditions at more than 35 sites across the country.
Historically, many recommendations for managing cardiovascular disease during pregnancy have relied on small studies or expert opinion. HOPE seeks to address those gaps by collecting detailed information on maternal outcomes, cardiovascular events, quality of life, patient-reported outcomes and cardiac imaging findings throughout pregnancy and postpartum.
Researchers hope the findings will improve risk prediction, refine clinical guidelines and support more personalized approaches to care.
Five Ways Health Care Teams Can Improve Maternal Cardiovascular Outcomes
As health care organizations continue to strengthen maternal safety efforts, Florio recommends focusing on five key strategies:
- Identify Risk Early: Screen patients for cardiovascular risk factors before pregnancy, during prenatal care and throughout the postpartum period.
- Standardize Risk Assessment: Use validated screening tools and structured approaches to consistently identify patients who may need additional evaluation or higher levels of care.
- Take Symptoms Seriously: Do not dismiss symptoms such as chest pain, shortness of breath, palpitations, fainting or unexplained swelling as normal pregnancy discomforts without appropriate evaluation.
- Use Available Resources: Leverage evidence-based tools such as the CMQCC Cardiovascular Disease in Pregnancy and Postpartum Toolkit and validated prediction models like CARPREG to support clinical decision-making.
- Build Coordinated Systems of Care: Establish clear referral pathways, multidisciplinary collaboration and postpartum follow-up processes to ensure patients receive ongoing cardiovascular care beyond pregnancy.
Looking Ahead
Improving maternal cardiovascular outcomes in Missouri will require a coordinated effort across specialties, health care settings and stages of life.
By focusing on preconception health, early risk identification, multidisciplinary collaboration and strong postpartum transitions of care, health care teams can help reduce preventable maternal morbidity and mortality while improving lifelong cardiovascular health for women across the state.
Every health care encounter is an opportunity to support maternal health — and every member of the health care team has a role to play.