PH, Pregnancy and Contraception
Pulmonary hypertension (PH) patients should avoid becoming pregnant because of the dangerous risks involved.
Medications used to treat pulmonary arterial hypertension, such as ambrisentan, bosentan, macitentan and riociquat, are toxic to fetuses. Discontinuing the medication puts the mother at risk of worsening PH. Some blood thinners increase the risk of fetal defects when used during pregnancy.
PH patients considering pregnancy should discuss questions about pregnancy, family planning and birth control with their PH specialists and gynecologists.
Risks for PH patients
- The heart and lungs can’t easily adjust to the extra demands of pregnancy and giving birth. As the 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.
- The increased blood volume can cause right heart failure. This happens because the heart is unable to handle the increased workload, impairing your physical capacity to handle the stress of pregnancy.
- The body’s changes during pregnancy increase the risk of blood clots, which can lodge in the lungs and cause a pulmonary embolism, which will further worsen your PH.
- Blood oxygen levels can decrease during pregnancy, creating the need for supplemental oxygen to support mother and child.
- Typical delivery-related blood loss can cause blood pressure to fall, which can lead to right heart failure and death.
- Anesthesia and pain medication used for C-sections also can lower blood pressure.
Risks for babies when mothers have PH:
- Increased risk of preterm birth.
- Low birth weight.
- Prematurity and lower survival rate.
Advisory to the PH Community: Abortion Access
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. The recent ruling allows states to set their own abortion policies, which means individuals have different levels of access to abortions depending on where they live.
Several states now ban abortion and more are expected to do so. 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.
Advisory for the PH Community on Alliance for Hippocratic Medicine v. FDA
The Pulmonary Hypertension Association (PHA) joins many health care organizations concerned about the April 7 Alliance for Hippocratic Medicine v. FDA ruling. The ruling aims to eliminate access to mifepristone for medicated abortion by challenging FDA’s approval of the drug. The case sets a dangerous precedent that erodes the Food and Drug Administration (FDA)’s approval authority.
On April 14, the Supreme Court issued a stay on the initial ruling in this case, preserving full access to mifepristone while an appeal moves forward.
PHA believes that the FDA’s drug-approval decisions and changes to drug-approval status should be issued only by the agency based on rigorous, ongoing review of relevant data with a focus on safety and efficacy, not by the courts.
This case is one of many that follows the Supreme Court’s decision to allow states to set their own abortion policies. PHA will continue to monitor these cases and advocate for medical care driven by clinical judgement and the patient-clinician relationship.
PHA Policy Statement on Abortion Access
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.