Those living with PH should discuss questions about pregnancy, family planning and birth control with their PH specialists and gynecologists to address risks, such as:
- Inability of the heart and lungs to adjust to the extra demands of pregnancy and giving birth. As pregnancy progresses, body fluid and blood volume increase, which increases cardiac output (the amount of blood pumped from the heart with every beat) and increases pulmonary artery pressure.
- Increased blood volume that can lead to right heart failure. This happens because the heart can’t handle the increased workload, impairing your physical capacity to handle the stress of pregnancy.
- Body changes during pregnancy that increase the risk of blood clots, which can lodge in the lungs and cause a pulmonary embolism, worsening your PH.
- Blood oxygen levels that may decrease during pregnancy, creating the need for supplemental oxygen to support mother and child.
- Typical delivery-related blood loss, which can cause blood pressure to fall and create a risk for right heart failure and death.
- Anesthesia and pain medication used for C-sections, which can also lower blood pressure.
PH medications and pregnancy
Some of the medications used to treat pulmonary arterial hypertension, such as ambrisentan, bosentan, macitentan, riociquat and sotatercept, are toxic to fetuses. Some blood thinners also increase the risk of fetal defects when used during pregnancy.
Discontinuing any medication will put mothers at risk of worsening PH.
In addition to maternal health, there also are risks for the baby. Maternal PH can increase some risks for infants including
- Increased risk for preterm birth
- Low birth weight
- Prematurity with a lower survival rate
Becoming pregnant is a personal decision that should be made with your health care team and loved ones. However, it is strongly advised to avoid because of the risks. There are other meaningful paths to parenthood that present fewer risks for parent and child.
Abortion access in the US
Americans’ constitutional right to abortion ended June 24, 2022, when the U.S. Supreme Court voted 6-3 to overrule the 1973 case, Roe v. Wade. This ruling allows states to set their own abortion policies, which means individuals have different levels of access to abortions depending on where they live.
While some states ban most or all abortions with no exceptions, other states have pledged to maintain access to abortions and offer support and legal aid for individuals seeking abortions.
PHA joins many health care organizations deeply concerned about unequal access to medically necessary care in the U.S.
Pregnancy is considered high risk for people with pulmonary hypertension because their heart and lungs can’t easily adjust to the demands of pregnancy and childbirth. Not only can pregnancy worsen PH symptoms, the risk of pregnancy-related heart failure is 30% to 50% and the estimated mortality rate is 30% to 56%. In addition, high-risk pregnancies are more likely to result in other medical complications that endanger the life of the pregnant person, the fetus, or both and can lead to life-long comorbidities.
PHA advocates for medical care driven by clinical judgment and the patient-clinician relationship, including legal, safe and affordable access to contraception and abortion. PHA recommends that people with PH who might become pregnant talk with their PH specialists and choose birth control method(s) right for their situations.
PH patients may need to terminate a pregnancy to save their lives or preserve their health or because they may be on medications that are teratogenic (can interfere with the normal development of a fetus). With the recent ruling, PH patients living in many states may not be able to find the medically appropriate care they need, leading to potentially dangerous outcomes and delays in care.
