What are the normal changes in breathing with pregnancy?
Pregnancy is a challenging time for the lungs. As the baby grows in the uterus, the abdominal cavity enlarges and compresses the chest cavity. The lungs are “smushed,” with less room to expand with each breath. Pregnant women often breathe a little faster and deeper to make up for the loss. There is an increased need for oxygen by the mother and baby. It is common to be a little short of breath when climbing the stairs or walking distances in pregnancy.
The enlarging belly often also pushes on the stomach, as much as it pushes on the lungs. This increases heartburn during pregnancy, and the stomach acid that comes up into the throat, can also trickle down into the lungs and cause more breathing difficulties. This is especially true of asthmatics; whose airways are particularly sensitive to irritants. When women try to sleep, the change in body position often makes both the breathing, and the heartburn, significantly worse. It may also partially block blood return to the heart. This is relieved when women either stand up or lay on their left side.
Many women will experience increased shortness of breath at nighttime when they are trying to sleep. Sometimes taking an antacid before bedtime, to decrease the reflux and heartburn when lying down, may make it easier to sleep. If possible, sleep in a semi-recumbent position (head more upright, about 30-45 degrees), and on your left side. This can usually be accomplished with pillows and foam wedges. Although, occasionally, sleeping in a recliner towards the end of the pregnancy may be more comfortable. Additional pillows between the knees or hugging them to the chest, may also offer some relief.
Are there any respiratory irritants that I should avoid inhaling in pregnancy?
Yes. Tobacco smoke is extremely bad for baby, even if you are not the one smoking. (i.e., secondhand smoke). You should also avoid inhaling dust from cat litter (i.e., changing cat litter boxes), as this may harbor an infection that is extremely bad for baby.
What are some of the medical problems that can lead to shortness of breath in pregnancy?
There are several common problems that lead to shortness of breath or cough in pregnancy. These include nasal congestion, heartburn, asthma, and sleep apnea. Nasal congestion is very common in pregnancy, especially when close to term. If the nasal congestion is minimal, some women will opt not to treat this because they dislike taking medications during pregnancy. However, if miserable, or the nasal congestion is impacting on your breathing, by either disrupting sleep or increasing asthma symptoms, then it should be treated as it is not healthy for either mom or baby. Heartburn can be evaluated in a similar fashion as mentioned previously in this book. Asthma, on the other hand, is worth reviewing. There are multiple medications that are used to control asthma. Frequently, women are managed on these medications, and then discover that they have a pregnancy. During pregnancy, the symptoms and severity of asthma can do one of three things: it can stay the same, it can get better, or it can get worse. Uncontrolled asthma is a health risk to both the mother and the baby. The worst thing that an asthma patient can do is suddenly to stop all of their medications during pregnancy. The best thing to do, is to see your Pulmonologist and discuss which medications you need or do not need during your pregnancy. If you notice that your asthma has suddenly gotten worse during your pregnancy, seek medical attention right away. One of the most important things for a developing baby, is an abundant supply of oxygen and normal perfusion of the placenta. This brings us to our last topic, sleep apnea in pregnancy. Many women have snoring during their pregnancy. The significance of snoring alone in pregnancy is not yet clear. However, it is becoming increasingly more apparent that breathing disorders, such as sleep apnea, during sleep in pregnancy, can have a profound effect on fetal growth and development. Talk to your doctor about sleep apnea, and if it needs to be treated, try to see a Sleep specialist and be treated as early in your pregnancy as you can.
Will my baby have asthma if I have asthma?
Time will tell. Some babies will, some will not. There are effective treatments for asthma in newborns, infants, and toddlers, so if you think that your child may have asthma they can be evaluated by a Pediatrician, Pediatric Pulmonologist and/or Allergist.
Is there anything I can do to prevent my child from getting asthma?
There are many factors involved in preventing asthma. Keeping your baby away from cigarette smoke will help. You should discuss with your Pediatrician appropriate use and timing of diet strategies and environmental strategies (such as, animal exposure) that may also be useful for your baby.
What respiratory testing can safely be done in pregnancy?
Common tests such as sputum cultures, pulse oximetry, peak flow rate, or blood work can easily be done. A chest x-ray or CAT scan of the chest can be performed with lead shielding at any time but is preferably avoided during the first trimester. An echocardiogram or MRI of the chest is safe at any time in the pregnancy. Doppler ultrasound studies of the legs can be performed at any time if abnormal blood clotting is suspected. Pulmonary function testing can be done, but it is recommended to avoid testing the DLCO, as this portion of the test requires carbon monoxide inhalation. Tests for influenza can be done at any time and are extremely beneficial as early treatment of this may lead to increased survival of both the mom and baby.
Self-Check for Better Breathing in Pregnancy
- I try to maintain an appropriate weight during my pregnancy.
- I sleep with plenty of pillows and keep the room a comfortable temperature. If I have loud snoring, gasping, or choking at night, I will see a Sleep specialist.
- Mild heartburn should be treated with over the counter medications after discussing with my doctor. Eating smaller meals and elevating the head of the bed may help.
- Sinus congestion can also be effectively treated during pregnancy.
- I have discussed with my doctor how to best manage my asthma during my pregnancy and what to do if I developed increased asthma symptoms.
- I have discussed with my doctor the proper timing to receive a pertussis booster vaccine and a flu vaccine.
Managing Doctors
- Primary Care
- Obstetrician
- Pulmonologist