Advancing Research and Care To Improve Maternal Heart Health

Sara Tabtabai, MD, first developed an interest in heart failure during medical school at the University of Connecticut School of Medicine. Although she was first attracted to physiology, she was drawn to the idea of building long-term relationships with patients.

“Heart failure has transformed from a disease that has high mortality and short lifespan, to one where we have great medications that can turn it into a chronic disease that can be managed,” says Tabtabai. “As cardiologists, we are able to help patients live their best lives, year after year.”

As she continued through her schooling and training at Massachusetts General Hospital, she carved out a niche for herself in caring for women with heart failure and other forms of cardiovascular disease. Now Tabtabai, who joined Yale School of Medicine in 2024, also delivers care to patients through the Yale Cardiovascular Disease and Pregnancy Program. The multidisciplinary program includes a team of cardiologists, maternal-fetal medicine specialists, lactation consultants, and other experts who provide comprehensive care to patients to prevent and manage heart conditions associated with pregnancy.

“Dr. Tabtabai is an outstanding physician who is distinguishing herself as a leader in maternal heart health,” says Eric Velazquez, MD, Robert W. Berliner Professor of Medicine (cardiovascular medicine) and chief of Yale Cardiovascular Medicine. “Her dedication to her patients and research is commendable, and we are thrilled to have her on our team.”

One of the conditions Tabtabai treats is peripartum cardiomyopathy, or heart failure during pregnancy or shortly after childbirth. Rates of this diagnosis are increasing both in the United States and globally, partly due to trends in maternal age and a rise in multiple births. While most patients have a good prognosis, the condition can be complicated to diagnose and treat.

“A challenge with peripartum cardiomyopathy is that many symptoms of heart failure, such as shortness of breath, fatigue, and swelling in the legs, are typical during pregnancy,” says Tabtabai. “It is crucial for us to recognize the symptoms so that we can accurately screen and diagnose patients.”

After a patient is diagnosed, Tabtabai and her colleagues work quickly to get them on medications to help their heart recover. Certain medications commonly used to treat heart failure are not safe in pregnancy or for women who are breastfeeding, so doctors must carefully tailor treatment regimens to meet each patient’s needs.

Tabtabai and her colleagues also work closely with each patient to help them understand their personal risk of recurrence in future pregnancies.

“We always ask if the patient wishes to become pregnant again, and if so, we counsel them about their associated risks and how to approach future pregnancies,” she says. “Before they attempt another pregnancy, we want to place them on pregnancy-safe medications and monitor them to ensure their heart function remains stable.

Tabtabai is now the site principal investigator for the REBIRTH clinical trial, which is evaluating whether a therapy called bromocriptine improves outcomes for patients with peripartum cardiomyopathy.

One arm of the study is a randomized controlled trial, where patients who are not breastfeeding will receive either bromocriptine or a placebo in addition to their standard heart failure therapy. A separate observational group will track a smaller number of patients who are breastfeeding with the goal of understanding the role of breastfeeding in diagnosing peripartum cardiomyopathy, including its effects on mental health and bonding between mother and child.

“The good news is that this is still a rare condition in pregnancy; however, the small population makes it challenging to conduct robust clinical trials,” says Tabtabai. “Additionally, our patients often have so many other appointments and commitments during this very vulnerable period, which makes it difficult for them to even consider joining a clinical trial.”

Tabtabai and her colleagues, Christine Hsueh, MD, assistant professor of medicine (cardiovascular medicine), and Patricia Chavez, MD, assistant professor of medicine (cardiovascular medicine), recently received a grant from the American College of Cardiology to improve education for the treatment of cardiovascular disease in pregnancy. The project will support a continued medical education course focused on counseling, diagnosing, and managing cardiac and vascular diseases of women of childbearing age throughout the continuum of their care during pregnancy.

“Our field has only recently started to understand the nuances of how cardiovascular disease and heart failure in particular affect women, and that is doubly true of pregnant women,” Tabtabai says. “Throughout my career, I want to help the field understand what we can do differently to try to have better outcomes for these populations.”

Cardiovascular Medicine, one of 10 sections in the Yale Department of Internal Medicine, is dedicated to improving cardiovascular health by advancing groundbreaking research, training the next generation of experts in cardiology, and delivering world-class patient care to people with a range of cardiovascular issues. To learn more, visit Cardiovascular Medicine.