How smartphones can deepen depression in older adults

Compulsive smartphone habits in older adults can be linked to a higher risk of depression, according to a study led by a Rutgers researcher. 

Researchers said their findings raised concerns that technology widely promoted to build connections can instead deepen late-life isolation: While mobile devices can be invaluable lifelines, their impact on mental health depends heavily on the way people use them. A critical distinction, the researchers said, is whether someone uses technology to actively engage with the world or to withdraw. 

“It comes down to purposeful interaction versus compulsive escapism,” said Chien-Chung Huang, a professor at the Rutgers School of Social Work and a senior author of the study. “The same device can bridge the gap to loved ones and community or serve as a wall to shut them out.”

The study, published in JMIR Aging, drew on survey responses from 2,585 adults ages 60 and older living in 87 communities throughout five districts of Guangzhou, China. Participants reported on their smartphone habits, communication preferences and offline social participation. Researchers also collected health and demographic information, including age, gender, marital status, education and income, and measured depressive symptoms with a screening tool commonly used with older adults.

The research team – which included study coauthors Sheng Chen and Yue Song, of the School of Public Administration at Guangdong University of Foreign Studies in Guangzhou – used machine learning to identify which factors were most strongly associated with depression. A secondary analytic method helped investigators look beyond any single explanation and recognize patterns that might not have been obvious from one variable alone.

Limited social participation emerged as the strongest predictor of depression, followed closely by smartphone addiction, defined as compulsive or excessive use that disrupts daily functioning. Problematic phone reliance appeared in nearly all cases of clinical depression, with older adults who rarely used interactive communication features facing the greatest risk.

The findings suggest that phone use can support well-being when it helps older adults maintain relationships, especially across distance, through video calls, messaging and photo sharing. Long stretches of scrolling, watching videos or playing games alone were associated with a pattern of withdrawal. 

“When an older adult uses their phone as a shield to substitute or displace real-life social participation, it acts as a major red flag for depression,” Huang said.

The study identified two groups that appeared especially vulnerable to depression. One pattern involved older men with less formal education who exhibited signs of smartphone addiction. For these adults, lower digital literacy may make it more difficult to navigate complex apps, increasing the likelihood that they will fall back on passive entertainment. 

Huang said depression risk may be especially pronounced among men in this group who have relied heavily on a spouse or partner for social connection and have fewer family or community ties to draw on later in life. 

“When they lose a partner or become isolated, they can be left without the same social buffers,” he said. “Their phone becomes an isolating crutch rather than a bridge.” 

Another high-risk pattern emerged among older adults of both sexes: Those with higher incomes and education levels who suffered from smartphone addiction were more prone to clinical depression. This finding suggests that wealth, education, and technology access fail to protect against loneliness when screen time replaces real-world connections. 

The researchers said the study doesn’t prove excessive smartphone use causes depression. Because the research captured one point in time, it cannot determine whether problematic phone use contributes to depressive symptoms, whether depression leads older adults to spend more time on their phones or whether the two reinforce each other.

Huang said the relationship is likely cyclical: An older adult who feels lonely may turn to screen time for distraction. 

“Over time, passive digital consumption can begin to replace the real-world interactions that help protect mental health,” deepening isolation and worsening depressive symptoms, he said.

Huang added that families, community organizations, and health providers can help by encouraging older adults to use phones in ways that support interaction rather than solitary entertainment. The goal is not to discourage smartphone use, but to make it more social and purposeful.

“Instead of leaving a senior to scroll videos alone, family members can involve them in photo-sharing loops, text threads, and scheduled video calls that help bridge intergenerational gaps,” Huang said.

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Blood pressure and cholesterol levels in adults over 40 with obesity

• In several high-income countries including England and the USA, adults over 40 years old with obesity now have blood pressure and unhealthy cholesterol levels approaching, or healthier than, people with a normal BMI, a significant shift from 30 years ago.
• This trend coincides with a greater rise in cholesterol-lowering medication (such as statins) and blood pressure medication use among adults over 40 with obesity compared to those with a normal BMI, pointing to medication as a likely driver of the blood pressure and cholesterol level convergence. 
• For adults under 40 years old, the study found little change in the gap between blood pressure and unhealthy cholesterol levels in people with obesity and those with normal BMI, likely because young adults rarely receive cholesterol or blood pressure medication regardless of their BMI.
• Authors say these findings suggest the cardiovascular risks associated with obesity in some countries have been reduced in older adults, however they highlight other risks associated with obesity remain, including diabetes, kidney and liver diseases, and cancers.
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Over the last three decades, differences in unhealthy cholesterol levels and blood pressure between older adults with obesity and those with a normal Body Mass Index (BMI) have narrowed or disappeared in several high-income countries, suggests a study published in The Lancet. The authors propose that this trend is due to the greater, and possibly more intensive, use of cholesterol-lowering medication (such as statins) and blood pressure medication in people aged over 40 living with obesity in high-income countries. 
 
Obesity is known to increase blood pressure and unhealthy cholesterol levels, which can impact cardiovascular health and increase the risk of heart attack, heart failure, and stroke. However, prior to this study, there was little information on blood pressure and cholesterol levels, and how they have changed, for people with obesity compared with people with normal BMI.
 
Author Prof Majid Ezzati, from the School of Public Health at Imperial College London (UK), says: “Our study suggests that, in high-income countries, taking medication to lower blood pressure and cholesterol has helped middle-age and older adults lower their cardiovascular risk to levels that are similar to people with normal BMI.”
 
He continues, “At a time that weight-loss medications are becoming more widely used, our results give a picture of the cardiovascular health of people likely to be prescribed them, which allows the healthcare system to understand how blood pressure and cholesterol treatments benefit the population alongside weight-loss medications.”
 
The study analysed data on blood pressure and cholesterol in people with obesity, overweight, and normal BMI from 110 health datasets including almost one million participants from 1990 to 2024 in seven high-income countries: England, the USA, Japan, South Korea, Taiwan, Thailand and Finland. 
 
Converging cardiovascular risk markers
 
The study finds that in the 1990s adults with obesity generally had higher blood pressure and high-density lipoprotein (non-HDL) cholesterol levels [1] than people with a normal BMI.
 
Since 1990, in the majority of the seven countries studied including England and the USA, blood pressure and unhealthy cholesterol fell more steeply among middle-aged and older adults (40–79 years old) with obesity and overweight than among those with normal BMI, narrowing the gap over time. The exceptions were Taiwan and Thailand, which did not see this convergence as universally as other countries.
 
The findings were most striking in older adults (60–79 years old). In England and the USA, older adults with obesity, and especially with severe obesity, had similar or even lower blood pressure and unhealthy cholesterol levels at the end of the study period than older adults with normal BMI.
 
Heart medication likely driving the convergence
 
Over the past three decades, people with obesity were more likely to be prescribed cholesterol-lowering medication (such as a statin) and blood pressure medication than those with a normal BMI. 
 
This gap was especially pronounced in older adults. For example, in England and the USA, around 70–72% of older men with severe obesity (BMI ≥35) were taking cholesterol-lowering medication by the early 2020s, compared with 40–48% of older men with a normal BMI.
 
Author Lakshya Jain, from the School of Public Health at Imperial College London (UK), says “This latest analysis suggests that the observed convergence in cholesterol and blood pressure levels between people aged over 40 with obesity and those with a normal BMI is largely due to statins and other widely accessible medications to reduce cardiovascular risk. That is a significant public health success story, and one we should not lose sight of as new weight-loss medications enter the picture.” 
 
Cardiovascular risks remain for younger adults with obesity
 
In younger adults (under 40 years old), the study findings suggest little or no narrowing of the gap in blood pressure or cholesterol between those with obesity and those with a normal BMI. The data also suggests that use of cholesterol-lowering and blood pressure medication is low for this age group, adding further evidence that medication is the driver of the gap reduction in older adults. 
 
Author Ysé d'Ailhaud de Brisis, from the School of Public Health at Imperial College London (UK), says "While good news for older adults with obesity, our results suggest that cardiovascular health risks remain higher for adults under 40 than for their counterparts with a normal BMI. Early lifestyle interventions, screening and, when appropriate, medication in this younger group should be considered to prevent long-term cardiovascular complications linked to obesity.”
 
The researchers note some limitations of the study, including that their analysis was limited to seven countries which were all high-income, therefore the finding may not be applicable elsewhere, especially for low- and middle-income countries where the use of unhealthy cholesterol and blood pressure lowering medicines is likely to be lower. Additionally, it was not possible to look at the impact of different medication doses, which require data on prescriptions. 
 
Writing in a linked Comment, Dr Yuan Lu, Yale School of Medicine (USA), who was not involved in the study, says, “This study reframes obesity-related cardiovascular risk as reflecting not only excess adiposity, but also treatment access, health-system engagement, and timing of intervention. Convergence of risk factors should not be equated with elimination of obesity-related risk. Although treatment of high blood pressure and cholesterol might mitigate part of the cardiovascular harm associated with obesity, the persistent burden among younger adults and the broader multisystem consequences of obesity highlight the need for integrated prevention strategies that move beyond isolated risk factor treatment.”
 

NOTES TO EDITORS

1. Non-HDL cholesterol, or ‘unhealthy’ cholesterol, is a measure of how much ‘bad’ cholesterol is in the blood. It measures cholesterol carried on Low-Density Lipoprotein (LDLs), Very Low-Density Lipoprotein (VLDLs) and other particles known to cause plaque buildup in blood vessels. It doesn’t include the ‘good’ (HDL) cholesterol. High levels of non-HDL are known to raise your risk of heart disease and stroke.

Exercise boosts smoking quit rates

 

A pack-a-day smoker can spend around $14,000 a year on cigarettes, yet despite the financial and health costs, quitting remains one of the most difficult changes many people will ever attempt.

Now, new research from Adelaide University shows that exercise can help people quit smoking by reducing cigarette consumption, easing cravings and improving their chances of quitting.

Researchers found that people taking part in exercise programs were 15% more likely to achieve continuous abstinence and 21% more likely to report not smoking over a seven-day period, compared with control groups.

They also found that exercise could reduce cigarette consumption by two cigarettes per day, and that a single bout of exercise immediately reduced cigarette cravings for up to 30 minutes after exercise.

The systematic review and meta-analysis examined 59 randomised controlled trials involving more than 9000 participants, exploring the effects of both single bouts of exercise and long-term exercise programs on smoking cessation, cravings, withdrawal symptoms and mood.

Globally, tobacco smoking remains the leading preventable cause of premature morbidity and mortality, accounting for about 7 million deaths, including an estimated 1.6 million non-smokers who are exposed to second-hand smoke.

Around the world, e-cigarette use has now reached more than 100 million people.

The researchers say exercise should be viewed as an additional tool that can be used alongside established smoking cessation support.

Lead researcher, Dr Ben Singh said the findings provide smokers with a practical, low-cost tool that can support their quitting journey.

“Quitting smoking is one of the best things a person can do for their health, but it’s also one of the hardest,” Dr Singh said.

“Many smokers want to quit, but the current approaches don’t work for everyone. That’s why we need more strategies that people can incorporate into their daily lives at little or no cost.

“Something as simple as regular exercise can make a meaningful difference to people trying to quit, helping them manage cravings, smoke less and improve their chances of quitting.”

While smoking rates have reduced over the past two decades, demand for e-cigarettes and heated-tobacco products have risen, targeting the younger generation.

Today, 80% of the 1.3 billion tobacco users worldwide live in low- and middle-income countries, yet in contrast, vaping has risen across many OECD countries.

Senior researcher Adelaide University’s Professor Carol Maher said exercise could be used strategically to ward off tobacco cravings.

“Quitting smoking does not have to begin and end with willpower alone,” Prof Maher said.

“Cravings can be difficult to manage, but they often pass. Our review found that even a single bout of exercise can reduce cravings for up to 30 minutes, which may help people get through some of the hardest moments of a quit attempt.

“Exercise should not replace evidence-based quit supports such as counselling and smoking cessation medication, but it may be a practical, low-cost strategy that people can use alongside them.”

The researchers say the next step is to test how exercise can be built into real-world quit programs, including digital, community and clinical services, and to examine whether it can also support people trying to quit vaping, where evidence is currently lacking.

Hearing loss in diabetes patients a ‘hidden epidemic’

 

Researchers have called for hearing tests to become a standard part of diabetes care and for hearing loss to be recognised as a significant complication of the condition.

Dr Mehwish Nisar from UQ’s School of Public Health said most people were unaware there was even a connection between hearing loss and diabetes.

“One in 4 adults with diabetes – or about 130 million people worldwide – are living with serious hearing loss,’’ Dr Nisar said.

“Diabetes is the world's fastest growing chronic disease, affecting over half a billion people, and people with diabetes are more than twice as likely to experience serious hearing loss.

“This isn't a minor inconvenience; hearing loss in people with diabetes often strikes working-age adults in their 40s and 50s, affecting daily conversations, fuelling isolation and creating significant communication challenges.

“This is a hidden epidemic, and we need to sound the alarm and add a simple hearing test to every diabetes check-up.’’

Researchers reviewed 29 studies involving more than 17,000 people worldwide, examining hearing loss in adults mostly with type 2 diabetes and prediabetes.

They found retinopathy (damage to the retina), nephropathy (kidney damage), and neuropathy (nerve damage) were recognised and routinely monitored complications.

However, hearing impairment was found to be a “significant, yet under-recognised, complication’’.

Dr Nisar said identifying hearing loss early allowed for timely hearing aid support to reduce isolation and support communication, as well as better glucose management to slow further deterioration.

“It is widely known that diabetes affects the eyes, kidneys, and nerves but almost no one knows it can also cause serious hearing loss,’’ Dr Nisar said.

“This research exposes the hidden sensory crisis affecting millions of people.

“Despite clear links, hearing loss is not yet systematically integrated into diabetes care protocols.

“Raising awareness of this hidden complication could help identify hearing problems earlier and improve quality of life for millions of people.’’

Dr Nisar said hearing loss progressed gradually, and patients were often unaware of a problem until it was more advanced.

“Crucially, clinically significant hearing loss is detectable through straightforward, low-cost audiometric screening, presenting a vital opportunity for early diagnosis and intervention,’’ she said.

“The more than 2-fold increased risk identified in this review supports the integration of routine audiometric screening into standard diabetes care, with particular urgency for younger adults.

“The damage may begin much earlier than people think and even people who have lived with diabetes for less than 10 years are more than twice as likely to develop significant hearing loss compared with those without diabetes.

“This is not just a concern for people with long-standing diabetes.

“Waiting for advanced complications before checking hearing is waiting too long.’’

Read the research in Diabetes Metabolism Research and Reviews.

Nearly half of dementia cases could be prevented by tackling modifiable risk factors

Nearly half of dementia cases could be prevented by tackling modifiable risk factors such as physical inactivity, smoking, low education or social isolation, but new Curtin University research suggests current public health approaches are falling short of driving real behaviour change.

 

A major international review published in The Lancet Healthy Longevity has found while large-scale health awareness campaigns for dementia prevention can reach wide audiences, they often lead to only small improvements in knowledge and limited changes in behaviour.

 

The study analysed public health campaigns and programs across eight countries and found more engaging, personalised and community-driven approaches were needed to genuinely influence behaviour and reduce dementia risk.

 

Study author Professor Mario Siervo, from Curtin’s School of Population Health, said the findings showed a clear gap between what people know and what they do.

 

“Up to 45 per cent of dementia cases are linked to modifiable factors we can change, such as our lifestyle, health status and environment,” Professor Siervo said.

 

“But simply telling people what those risks are isn’t enough; awareness campaigns are important, but on their own they rarely lead to meaningful or lasting behaviour change.”

 

Professor Siervo also said a second new study conducted by the group has provided further evidence on the relevance of modifiable risk factors for dementia.

 

The results indicated that muscle strength and body composition play a significant role in dementia risk, highlighting the need for more targeted prevention approaches.

 

The Curtin-led research followed nearly 500,000 adults over more than a decade and found people with both low muscle strength and excess body fat — known as sarcopenic obesity — had a higher risk of developing dementia.

 

In contrast, obesity on its own was not associated with increased dementia risk if muscle strength was preserved, highlighting the importance of muscle health alongside maintaining an optimal body composition in dementia prevention.

 

Chair in Dementia at Curtin’s enAble Institute and co-author Professor Blossom Stephan said many people still did not realise dementia risk could be reduced.

 

“There is still a widespread belief that dementia is an unavoidable part of ageing, which is not the case,” Professor Stephan said.

 

“But even when people are aware of the risks, barriers such as time, cost and motivation can prevent them from making changes to their lifestyle.”

 

The review found interactive approaches were consistently more effective in motivating people to make lifestyle changes than passive information campaigns.

 

These included:

• Online education programs that guide people through practical steps to improve brain health
• Personalised risk assessments showing individuals how their lifestyle affects their dementia risk
• Community-based programs delivered by trusted local figures, such as peer educators, health workers or community leaders

 

Professor Siervo said these types of approaches were more likely to engage people and support sustained behaviour change.

 

“When people understand their own personal risk and are given clear, practical ways to act – especially through trusted community networks – they are more likely to make meaningful changes,” he said.

 

Examples of effective approaches included community education sessions run by local leaders, culturally tailored programs delivered in familiar settings and interactive courses helping participants set realistic health goals.

 

Professor Stephan said future public health strategies should move beyond awareness alone and focus on long-term engagement.

 

“We need to combine broad public messaging with targeted support that helps people take action,” she said.

 

“That means investing in programs that are accessible, culturally relevant and designed with communities, not just delivered to them.

 

“With dementia rates expected to rise significantly in coming decades, prevention is one of the most powerful tools we have -but to get there, we need to rethink how we communicate risk and support people to act on it.”

 

Population-level interventions for dementia prevention: a systematic review was published in The Lancet Healthy Longevity.

 

Creatine shows promise for depression

 Walk into any gym supplement aisle and creatine is there, sold by the tub to people chasing bigger muscles. It is one of the most studied compounds in sports science. What far fewer people know is that the brain runs on much the same chemistry the muscles do, and that the energy creatine helps supply may matter just as much above the neck as below it. A new systematic review, published today in Brain Medicine, takes that quiet possibility seriously and asks a hard question. Can creatine help treat depression?

What the Researchers Looked At

The team behind the review, led by Bassam Jeryous Fares of the University of Ottawa, did not run a new trial. They gathered the ones that already existed. After screening the literature, they settled on six published reports describing five randomized controlled trials, the kind of study in which neither patient nor doctor knows who received the real compound and who received a placebo. Those trials had been conducted across five countries, in South Korea, the United States, Brazil, Israel, and India, and together they enrolled 238 participants at baseline, 126 on creatine and 112 on placebo. The average age was 36 years. Most participants were women. Two of the trials enrolled women only.

Four of the trials studied major depressive disorder. One studied people with bipolar disorder who were living through a depressive episode. Because the studies differed so widely in design, the authors did not pool the numbers into a single statistic. They summarized them in narrative instead, letting each trial speak for itself.

A Split Decision

Here is where the story refuses to resolve cleanly. Two of the five trials, both drawn from the same study of women with major depressive disorder, found real benefit. When five grams of creatine per day was added to the antidepressant escitalopram, depressive symptoms fell further than they did on placebo after eight weeks. The effect was large by the usual statistical yardsticks, with a Cohen's d of 1.13 on the Hamilton Depression Rating Scale, and more women reached remission. A separate trial paired creatine with cognitive behavioral therapy and saw a steeper drop in symptoms on a standard questionnaire than therapy plus placebo produced.

Then the picture darkens. The remaining three trials found nothing. One saw no effect of creatine, at five or ten grams daily, in people who had already failed to respond to medication. Another, testing several doses in adolescent girls, found no difference from placebo. The last looked at people with bipolar disorder in a depressive episode and again found no treatment benefit. Worse, two of those bipolar patients taking creatine developed hypomania or mania, a sober reminder that the same compound can behave very differently depending on the diagnosis.

Why Creatine Might Matter for the Brain

The logic behind the experiments is not far fetched. The brain is an expensive organ, burning energy at a rate out of all proportion to its size, and creatine helps cells rebuild adenosine triphosphate, the molecule that pays for that work. Studies of people with mood disorders have found altered creatine metabolism in the brain, and impaired energy production has been proposed as one root of depression. Creatine may also nudge the pathways that govern dopamine and serotonin, the neurotransmitters that most antidepressants target. The authors are careful here. They note that the link between brain creatine and mood remains correlational, not proven cause and effect, and that the biology of depression has many moving parts.

“The signal is interesting, but it is not a verdict,” said Bassam Jeryous Fares, first author of the review and a student in the Faculty of Medicine at the University of Ottawa. “Two trials pointed one way and three pointed another. That is not the kind of evidence on which you change clinical practice. It is the kind that tells you the question is worth further exploration.”

Nicholas Fabiano, corresponding author and a psychiatry resident at the University of Ottawa, framed the work as a starting point rather than a conclusion. “Creatine appears to be a safe intervention. The adverse events we found were limited to mild gastrointestinal discomfort. We cannot yet reliably say that creatine helps with depressive symptoms or if the findings are generalizable to everyone.”

What Comes Next

The review does not pretend to settle the matter. The authors flag the obvious limitations. The trials were small. The sexes were unbalanced, with two studies enrolling only women. The quality varied, with two trials judged at low risk of bias and three carrying some concern, arising mostly from how patients were assigned and how missing data were handled. The findings, the authors stress, are not yet generalizable.

What they call for is more rigorous work. Larger trials. Longer ones, running past the eight week mark. Studies that test creatine alongside exercise, and studies that explore higher doses, while keeping in mind that more is not always better. There is even a tantalizing clue from animal research, where creatine altered depression like behavior differently in male and female rodents, which may help explain why the human trials with more women showed more promise. For now, creatine remains a promising lead rather than a proven remedy. The molecule that builds muscle has earned a closer look from the people who study the mind.

The peer-reviewed research article in Brain Medicine titled “Creatine as a treatment for depression,” is freely available via Open Access, starting on 30 June 2026 in Brain Medicine at the following hyperlink: https://doi.org/10.61373/bm026l.0039.

The full reference for citation purposes is: Jeryous Fares B, Zhou C, Fabiano N, Wong S. Creatine as a treatment for depression. Brain Medicine 2026. DOI: https://doi.org/10.61373/bm026l.0039. Epub 2026 Jun 30.

Heart failure symptoms during and after pregnancy

 

Earlier diagnosis, prompt treatment and follow-up care after delivery are critical to help prevent life-threatening complications for pregnant and postpartum women with heart failure, according to a new American Heart Association scientific statement

Statement Highlights:

• Current evidence indicates that nearly 1 in 4 women 20-44 years of age currently has some type of cardiovascular disease, and heart disease is now one of the leading causes of pregnancy-related death in the U.S.
• Heart failure symptoms, such as shortness of breath, fatigue and swelling, often resemble common symptoms experienced during pregnancy and after delivery, which can delay heart failure diagnosis and treatment. This can have life-threatening consequences for both mother and baby.
• The first year after delivery is a high-risk time for women to develop heart failure, and postpartum women need ongoing follow-up care after delivery.
• Standard screening, prompt treatment and coordinated care between obstetricians and heart specialists may help improve maternal health and save lives.

Early detection and timely treatment of heart failure in pregnant or postpartum women are crucial to prevent serious complications, such as irregular heartbeat, stroke and death, according to a  new American Heart Association scientific statement, “Heart Failure Occurring in the Perinatal Period.”  

Heart failure is a serious condition in which the heart cannot pump enough blood well enough to meet the body’s needs. The true prevalence of heart failure during pregnancy and the postpartum period is unknown. However, according to a 2026 American Heart Association scientific statement Forecasting the Burden of Cardiovascular Disease and Stroke in Women, nearly 1 in 4 women 20-44 years of age currently have some type of cardiovascular disease. Data from the U.S. Centers for Disease Control and Prevention’s Pregnancy Mortality Surveillance System indicates that heart disease is now one of the leading causes of pregnancy-related death in the U.S.

A new scientific statement, published today in the American Heart Association’s flagship peer-reviewed scientific journal Circulation, highlights the challenges of recognizing heart failure in pregnant and postpartum women and emphasizes the need for prompt treatment as well as continued monitoring after delivery.

“Heart failure affects more than just the heart—it can affect the lungs, kidneys, brain and more,” said Demilade A. Adedinsewo, M.D., M.P.H., chair of the volunteer scientific statement writing group and an assistant professor in the department of cardiovascular medicine at the Mayo Clinic in Jacksonville, Florida. “Because blood flow is reduced and fluid builds up, it can lead to breathing difficulties, kidney issues, irregular heartbeats and increased risk of stroke and death.”

What are the symptoms of heart failure during pregnancy and postpartum?

Symptoms of heart failure include shortness of breath, labored breathing, fatigue and weight gain with swelling in the legs and feet. Since these symptoms are also common in otherwise healthy pregnancies, heart failure in women who are pregnant or have recently given birth often goes unrecognized.

Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is a form of heart muscle failure that can develop late in pregnancy or months after delivery. Women who develop PPCM may experience and report various heart failure symptoms due to fluid retention.

“Heart failure during and after pregnancy is often hiding in plain sight. By recognizing symptoms earlier and initiating appropriate treatment, especially in the postpartum period, clinicians and health systems have a powerful opportunity to prevent serious complications and save mothers’ lives,” said Adedinsewo.

What are the risk factors for heart failure?

Heart failure in the perinatal period can affect women who already have cardiovascular disease and those who do not. Risk factors for heart failure in general include high blood pressure, Type 2 diabetes, abnormal cholesterol, overweight/obesity or metabolic syndrome. During the perinatal period, unique risk factors include known heart disease prior to pregnancy, older maternal age, multiple gestation, known genetic variants for heart failure, use of assisted reproductive technology and prolonged use of tocolytic agents (medications used to suppress premature labor). Among women with known heart disease, heart failure is the most common complication, affecting 11% of women during pregnancy and in the postpartum period.

However, significant disparities exist in perinatal heart failure risk and outcomes in the U.S.:

• Black adults have about a 19% higher risk of developing heart failure than white adults. 
• Black women and Native American women were more frequently diagnosed with PPCM than white women. Black women with PPCM were also more likely to be diagnosed later compared to other racial groups.
• Heart failure or abnormal cardiac function contributed to 14.5% of pregnancy-related deaths among American Indian/Alaska Native women and 14.2% among Black women.

What are the risks if heart failure is not diagnosed and treated promptly?

Heart failure poses substantial risks to the health of a mother and baby. Delays in recognizing and diagnosing heart failure during the perinatal period can be life-threatening. Data from a national database found that women who are pregnant and have heart failure are about 32 times more likely to die around the time of delivery compared to pregnant women who do not have heart failure.

Other risks for the mother include irregular heartbeat, stroke, worsening cardiac function, preterm delivery, caesarean delivery, postpartum hemorrhage, poor mental health and poor quality of life. Heart failure in the mother during pregnancy increases the risk of restricted fetal growth, premature birth, low birth weight, a prolonged stay in the pediatric intensive care unit, stillbirth or death in the first four weeks of an infant’s life.

How is heart failure diagnosed in pregnant and postpartum women?

Knowing the signs and symptoms of heart failure, as well as prompt medical evaluation and testing, are crucial first steps in improving women’s health. The statement emphasizes that it is important for clinicians to evaluate patients with any heart symptoms during pregnancy, particularly if they have other cardiovascular risk factors.

Diagnostic testing, such as electrocardiograms (ECG), blood tests for cardiac biomarkers and echocardiograms, can help clinicians distinguish between normal pregnancy changes and warning signs of heart failure.  

How is heart failure managed during pregnancy?

Although there is no cure for heart failure, it can be managed with medications and healthy lifestyle. Many women with new onset of heart failure in the perinatal period recover heart function with appropriate care. Treatment is guided by the severity of the disease. Medications to treat heart failure that may be considered safe in pregnancy include beta blockers, diuretics, vasodilators and anticoagulants (when appropriate). The priorities are to stabilize maternal heart function and ensure the fetus is receiving adequate blood flow. A multidisciplinary cardio-obstetrics team to provide continuous monitoring and treatment is critical for optimal care.

Achieving optimal cardiovas­cular health, as outlined by the American Heart Associa­tion’s Life’s Essential 8 metrics, is increasingly recognized as important before, during and after pregnancy. People with heart failure who follow a healthy eating plan, engage in regular physical activity and get support from family and friends often report greater improvement in managing symptoms and emotional well-being.

Why is the postpartum period critical?

The postpartum period, which extends through the first year after delivery, is a particularly high-risk time for women to develop heart failure. Some women first experience symptoms within the first few days after childbirth, while others develop symptoms weeks or months after delivery. Referrals from obstetric care/maternal-fetal medicine specialists to other health care professionals, whether cardiology or primary care, are an essential component of high-quality postpartum care beyond the traditional 6-week postpartum period. Continued monitoring during the first year after delivery may include home visits and alternatives to in-person appointments, such as telemedicine and using digital technologies for remote monitoring and symptom assessments.

Counseling about contraception is also an important consideration for postpartum women. Long-acting reversible contraceptives (LARCs), specifically hormonal intrauterine devices, are the preferred method of contraception for women with cardiovascular disease including heart failure. Estrogen-containing methods are not recommended for women with moderate or severe heart failure due to the increased risk for thrombosis (blood clots in the veins and arteries).

“Improving postpartum care is essential to protecting maternal health. Standardized screening, listening carefully to patient concerns and improved access to care are crucial to help improve outcomes for mothers and their families,” said Adedinsewo.

Additional Resources:

•  view the manuscript online.
• American Heart Association scientific statement news release: 6 in 10 U.S. women projected to have at least one type of cardiovascular disease by 2050 (Feb. 2026)
• American Heart Association news release: Risk factors for cardiovascular disease negatively impact health during, after pregnancy (Oct. 2025)
• American Heart Association news release: New postpartum care recommendations target CVD risk (May 2024)
• American Heart Association scientific statement news release: Heart disease risk factors in women highlight need for increased awareness, prevention (Feb. 2024)
• American Heart Association/ACC Guideline: 2022 Guideline for the Management of Heart Failure (May 2022)
• American Heart Association Policy Statement: Call to Action: Maternal Health and Saving Mothers (Aug. 2021)
• American Heart Association health information: Pregnancy and Maternal Health