Managing Mild Pulmonary Hypertension During Early Pregnancy: What to Know

Shortness of breath in early pregnancy, diagnosed with mild pulmonary hypertension through echocardiography?

Hello Doctor: I am currently six weeks pregnant, and this is my first pregnancy.
Not long before I became pregnant, I noticed that I was more easily short of breath while talking, eating, and exercising.
During half an hour on the treadmill, my heart rate exceeded 160 beats per minute, and I felt very fatigued after exercising, but I thought it was due to a lack of fitness and didn't pay much attention to it.
However, after learning about my pregnancy, I experienced shortness of breath while walking and climbing stairs, daily fatigue, weakness while talking, difficulty catching my breath while eating, and a need for longer sleep and naps...
The fatigue and shortness of breath are particularly pronounced.
A few years ago, I was diagnosed with mitral valve prolapse and regurgitation by a cardiologist, so after learning about my pregnancy, I went to a cardiologist for an echocardiogram.
The doctor informed me that my pulmonary pressure was slightly elevated (35) and that I had tricuspid regurgitation.
However, the doctor only advised me to return for a follow-up if my shortness of breath or edema worsened; otherwise, I could return after delivery.

Additionally, my recent blood pressure has been low at 97/56, and my heart rate is relatively fast at about 85-100 (my pre-pregnancy blood pressure was approximately 105/60, and heart rate was 75).
I also have a congenital ectopic thyroid (lingual thyroid) and hypothyroidism, for which I have been taking levothyroxine for nine years, with regular blood tests keeping my levels within normal ranges (thyroid-related indices were also normal during pregnancy).
Furthermore, I am currently taking prenatal medications prescribed by a traditional Chinese medicine doctor, folic acid, and B vitamins.

After learning about the slightly elevated pulmonary pressure combined with the diagnosis of tricuspid regurgitation, I am very worried.
I have researched a lot online, and most sources indicate that pulmonary hypertension during pregnancy can be very dangerous.
I am particularly concerned that having slightly elevated pulmonary pressure so early in my pregnancy may worsen in the future.
I am in a state of constant anxiety, and after struggling to conceive, I truly hope to have a successful delivery.

I would like to ask the doctor: How can I manage my slightly elevated pulmonary pressure to prevent it from increasing? Is there any danger associated with it being slightly elevated? What should I do next regarding my situation? Should I see a specialist for further tests? Are there any special precautions I need to take during delivery? Or do you have any other valuable suggestions? Thank you for your assistance, Doctor!

Yiyi, 30~39 year old female. Ask Date: 2019/03/24

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I am currently six weeks pregnant, and this is my first pregnancy.
Not long before I became pregnant, I noticed that I was easily short of breath while talking, eating, and exercising.
When using the treadmill for half an hour, my heart rate exceeded 160 beats per minute, and I felt very fatigued after exercising.
At that time, I thought it was due to a lack of exercise and didn't pay much attention to it.
However, after learning about my pregnancy, I experienced shortness of breath while walking and climbing stairs, felt tired every day, had weak speech, and found it hard to catch my breath while eating.
I also needed longer sleep and naps, with fatigue and shortness of breath being particularly pronounced.

A few years ago, I was diagnosed with mitral valve prolapse and regurgitation by a cardiologist, so after discovering my pregnancy, I went to a cardiology department for an echocardiogram.
The doctor informed me that my pulmonary pressure was slightly elevated (35) and that I had tricuspid regurgitation.
However, the doctor only advised that I return for a check-up if my shortness of breath or edema worsened; otherwise, I could come back after delivery.

Additionally, my recent blood pressure has been low at 97/56, and my heart rate is relatively fast at about 85-100 (my pre-pregnancy blood pressure was around 105/60, and heart rate was 75).
I also have a congenital issue with ectopic thyroid (lingual thyroid) and hypothyroidism, for which I have been taking levothyroxine for nine years, with regular blood tests keeping my levels within the normal range (thyroid-related indices were normal during pregnancy).
Furthermore, I am currently taking prenatal medications prescribed by a traditional Chinese medicine doctor, folic acid, and B vitamins.
After learning about the slightly elevated pulmonary pressure combined with tricuspid regurgitation, I am very worried.
I have researched a lot online, and most sources indicate that pulmonary hypertension during pregnancy is very dangerous.
I am concerned that having slightly elevated pulmonary pressure so early in my pregnancy may worsen as time goes on.
I am in a constant state of anxiety; I have worked hard to become pregnant and truly hope to have a smooth delivery.
I would like to ask the doctor: How can I manage my slightly elevated pulmonary pressure to prevent it from increasing? Is there any danger associated with it being slightly elevated? What should I do next regarding my situation? Should I see a specific specialist for further examinations? Are there any special precautions I need to take during delivery? Or do you have any other valuable suggestions?
Answer: Your situation is classified as high-risk pregnancy, and you should seek care and treatment from a high-risk pregnancy department at a medical center.

Reply Date: 2019/03/24

More Info

Managing mild pulmonary hypertension during early pregnancy can be a complex and concerning issue, especially for first-time mothers. Your situation, as described, involves several factors that need careful consideration. First, it’s important to understand what pulmonary hypertension is and how it can affect both you and your baby during pregnancy.

Pulmonary hypertension (PH) is characterized by elevated blood pressure in the pulmonary arteries, which can lead to various complications, particularly during pregnancy. The normal pulmonary artery pressure is typically around 8-20 mmHg, and a pressure of 35 mmHg, as you mentioned, indicates mild pulmonary hypertension. While this may not seem severe, it can still pose risks, especially in the context of pregnancy, where the body undergoes significant physiological changes.

Risks and Management Strategies
1. Monitoring Symptoms: Given your history of symptoms such as shortness of breath, fatigue, and palpitations, it’s crucial to monitor these closely. If you experience worsening symptoms like increased shortness of breath, swelling in your legs, or chest pain, you should seek immediate medical attention.

2. Regular Check-ups: You should continue to have regular follow-ups with your healthcare provider, particularly a maternal-fetal medicine specialist or a cardiologist who specializes in pregnancy-related heart issues. They can provide tailored advice and monitor your pulmonary pressures throughout your pregnancy.

3. Lifestyle Modifications: Engaging in light physical activity, as tolerated, can help improve your overall cardiovascular health. However, avoid strenuous activities that may exacerbate your symptoms. Maintaining a healthy diet, staying hydrated, and managing stress through relaxation techniques can also be beneficial.

4. Medication Review: It's essential to review all medications you are currently taking, including any supplements or herbal remedies. Some medications may not be safe during pregnancy, and your healthcare provider can help you determine which ones are appropriate.

5. Addressing Anxiety: Your anxiety about the condition is understandable. Consider discussing your concerns with a mental health professional or joining a support group for expectant mothers with similar health issues. This can provide emotional support and coping strategies.

6. Delivery Planning: As your pregnancy progresses, discussions about delivery should include considerations for your pulmonary hypertension. Depending on how your condition evolves, your healthcare team may recommend a specific delivery plan, possibly involving a specialized team at a hospital equipped to handle high-risk pregnancies.

Potential Complications
Mild pulmonary hypertension can lead to complications such as preterm birth, low birth weight, and in some cases, heart failure. However, many women with mild PH can have successful pregnancies with appropriate management. The key is to maintain open communication with your healthcare team and adhere to their recommendations.

Conclusion
In summary, while mild pulmonary hypertension during early pregnancy can be concerning, with proper management and monitoring, many women can navigate this condition successfully. Focus on maintaining a healthy lifestyle, attending regular check-ups, and managing any symptoms or anxiety you may have. Always consult your healthcare provider before making any changes to your treatment plan or lifestyle. Your health and the health of your baby are of utmost importance, and with the right support, you can work towards a healthy pregnancy and delivery.

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