Postpartum adjustment among women with heart disease in pregnancy: a qualitative study

Pregnancy with heart disease (PWHD) is a significant high-risk category, leading to adverse cardiovascular events and indirect maternal deaths. Despite advancements in perinatal care improving outcomes, the postpartum period remains high-risk for cardiovascular issues. Postpartum women face physical, psychological, and maternal role adjustments, with those having heart disease at higher risk for adjustment disorders. This study investigates the real experiences of postpartum adjustment in these patients. Researchers conducted a qualitative study using reflexive thematic analysis. Semi-structured face-to-face interviews were conducted with 24 purposively sampled postpartum women with pregnancy-complicated heart disease recruited from a provincial tertiary hospital in Zhejiang Province, China, from May to September 2025. Interviews were audio-recorded, transcribed verbatim, and analysed using NVivo 15 to generate themes and subthemes. Five core themes and 16 sub-themes were identified: the dual burden of heart disease and postpartum challenges, psychological vulnerability and heightened emotional fluctuations, family support tension and intergenerational negotiation, gaps in disease understanding and health management skills, and the retreat from motherhood with a need for role repositioning. These findings enhance the understanding of the complex challenges faced by women with pregnancy-related heart disease during postpartum adaptation. They emphasise the importance of care that goes beyond disease monitoring to include psychological, familial, and educational support. Implementing integrated, multidisciplinary postpartum care with family involvement and targeted support can foster better recovery and improve quality of life. This approach also contributes to developing comprehensive “fourth trimester” care models for sustained maternal and infant health.