Pulmonary Hypertension During Pregnancy

Pulmonary hypertension (PH) is a rare and serious heart and lung condition that makes it hard to breathe. It’s especially dangerous and life-threatening for a pregnant woman and her unborn baby. All women with PH who are of child-bearing age should understand the risks of pregnancy and pulmonary hypertension.

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What Is Pulmonary Hypertension?

Pulmonary hypertension (PH) is a chronic condition where the blood pressure in vessels between your lungs and heart is abnormally high. It causes the arteries in your lungs to become stiff and narrow, which reduces blood flow through your lungs.

If you have pulmonary hypertension, you may not get enough oxygen in your blood. This condition also causes your heart to work harder, which may increase your risk of heart failure. PH causes symptoms like:

  • Fatigue.
  • Shortness of breath while exercising or at rest in more advanced stages.
  • Dizziness or fainting.
  • Blue lips or fingers
  • Swelling in your feet, legs, and eventually belly and neck.
  • An irregular or fast heartbeat.
  • Chest pain.

This rare disease affects more women than men. There is no cure, but you can manage it with medicines, lifestyle changes, and surgery if necessary.

Pregnancy and Pulmonary Hypertension

PH is dangerous for anyone, but even more so for pregnant women. If you have PH and become pregnant, it’s important to contact your doctor immediately so you can be followed closely. During pregnancy, your heart and blood vessels undergo many changes. Blood volume increases significantly, and your heart works harder to pump extra blood to you and your baby.

If you have pulmonary hypertension during pregnancy, arteries in your heart and lungs can’t keep up with your extra blood volume. As a result, both you and your baby are at risk of inadequate blood flow and oxygen.

PH increases your risk of early delivery and having a low-birth-weight baby. Also, labor and delivery cause significant stress on your cardiovascular system, which could increase your risk of heart failure.

Having pulmonary hypertension during pregnancy can put your life and your baby’s life at risk. Because of the dangers to both mom and baby, most doctors recommend that women with pulmonary hypertension avoid pregnancy.

“High blood pressure in pregnancy carries an increased risk both for mom and for baby,” Dr. Malamo Countouris, MD, UPMC Magee-Womens, tells WPXI. “Those risks include pre-term delivery, and with preeclampsia you can see severe cardiovascular disease.”

Those risks include heart failure, heart attack, and even stroke, she says.

If you have PH and are of childbearing age, it’s essential to talk to your doctor about birth control. They may recommend these forms of permanent contraception:

  • Tubal ligation (also known as “having your tubes tied”). Your doctor makes a tiny incision into your belly button. Then they insert a laparoscope and use it to cut and tie off your fallopian tubes.
  • Tubal implants. These are tiny metal springs that your doctor places in each of your fallopian tubes. For this procedure, they don’t have to cut your skin. Instead, they pass a thin catheter with the implants through your vagina, cervix, uterus, and into your fallopian tubes.
  • A vasectomy for your partner. This procedure is a form of male birth control that blocks sperm from getting into semen.

These procedures are the most effective way to permanently prevent pregnancy. If you don’t want a permanent form of contraception, a copper or progestin-only IUD may be a good option.

Oral contraceptives with estrogen are effective, but not recommended when you have PH. Estrogen increases the risk of developing a blood clot that can travel to your lungs, which is especially dangerous with pulmonary hypertension.

Barrier methods of birth control, like condoms, a diaphragm, or a cervical cap, are far less effective at preventing pregnancy.

What If Pulmonary Hypertension Starts During Pregnancy?

It’s important to note that PH is rare, and pregnancy itself isn’t a risk factor. Sometimes PH happens for no specific reason. But it’s more likely to occur if you have a family history or an underlying health condition like certain forms of heart or lung disease.

It’s not uncommon to have no or only mild symptoms like fatigue or shortness of breath for years before a PH diagnosis. Some women have it and don’t find out until after getting pregnant when their symptoms worsen. If you have risk factors tell your doctor early in your pregnancy so they can screen and monitor you for PH with these tests:

  • Echocardiogram. A type of ultrasound that lets your doctor view live pictures of how your heart pumps blood.
  • Electrocardiogram (ECG). A test that checks your heart’s electrical activity using electrodes taped to your chest.
  • Exercise stress testing. Also known as a treadmill test, this lets doctors see how your heart works during exercise.
  • Lung function tests. These tests show how well your lungs work as you breathe into a mouthpiece connected to a machine.

Pregnancy with pulmonary hypertension is extremely high risk, so you’ll need extra care from a team of specialists throughout your pregnancy. You’ll likely have frequent visits every one to two weeks with your obstetrician plus heart and lung specialists. They’ll watch you carefully to make sure your heart, lungs, and baby are all healthy.

The most dangerous time for pregnancy pulmonary hypertension is at the end of your pregnancy and within two months after delivery. This is because of the rapid changes in your body’s fluid volume.

During your pregnancy, your doctor might recommend:

  • Oxygen therapy (a portable oxygen tank) to help you get enough oxygen.
  • Medicine to help manage PH during your pregnancy.
  • Induced vaginal delivery at 32 to 34 weeks if you don’t have any complications.
  • A planned C-section if you have heart failure or other complications.
  • An epidural instead of general anesthesia during a C-section. General anesthesia puts extra stress on your heart and the blood vessels in your lungs.

Your risk of life-threatening complications remains high for two months — or even longer — after your baby is born. Therefore, it’s crucial to have close contact with your medical team. Make sure you have plenty of help for you and your baby.

There’s a lot to consider about pulmonary hypertension and pregnancy. It’s extremely important to talk to your medical team and understand the risks. Your medical team is here to support you and evaluate all your options.

Editor's Note: This article was originally published on , and was last reviewed on .

Sources

Women's Health and Lung Disease. Pulmonary Hypertension Complicating Pregnancy. LINK

American College of Cardiology. Statement on Pregnancy in Pulmonary Hypertension. LINK

European Heart Journal Supplements. Screening Strategies for Pulmonary Arterial Hypertension. LINK

About Heart and Vascular Institute

The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.

About UPMC Magee-Womens Hospital

For more than a century, UPMC Magee-Womens Hospital has provided high-quality medical care to women at all stages of life. UPMC Magee is long-renowned for its services to women and babies but also offers a wide range of care to men as well. Our patient-first approach ensures you and your loved ones get the care you need. Nearly 10,000 babies are born each year at Magee, and our NICU is one of the largest in the country. Our network of care – from imaging centers to hospital services – provides care throughout Pennsylvania and Maryland, giving you a chance to get the expert care you need close to home. The U.S. Department of Health and Human Services recognizes UPMC Magee as a National Center of Excellence in Women’s Health, and the Magee-Womens Research Institute is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology.