Managing Respiratory Conditions During Pregnancy (video/podcast)

It’s often noted that a pregnant woman is “eating for two”— but rarely discussed is that’s she’s also breathing for two. Pregnancy brings lots of changes to a woman’s body and that includes her respiratory system.

In this video, San Diego Health host Susan Taylor talks about respiratory conditions and pregnancy with Jennifer Namazy, MD, an allergist and immunologist at Scripps Clinic Mission Valley.

While many people think the respiratory system is just the lungs, there is much more to it. In fact, the respiratory system is a network of organs and tissues that also includes the nose, mouth, throat, sinuses and trachea (commonly called the windpipe).

One of the most common respiratory concerns during pregnancy is asthma. About 60% of expecting moms who have asthma find that their condition worsens during pregnancy. If asthma is not well-controlled before pregnancy, the risk of it being even more problematic during pregnancy is higher.

“If you’re needing to go to the emergency room or going to see your doctor on an urgent basis to control symptoms of asthma, that likely means that your asthma is not controlled,” says Dr. Namazy. “It’s really important to capture these patients even in the childbearing ages to help control their asthma before they get into the family planning stage.”

Even when their asthma is well-controlled, some women may be concerned about the potential effects of medications on their developing babies. Data shows that many patients stop their medications, causing asthma to worsen.

“Generally, most of the commonly used asthma medicines are safe during pregnancy, but it’s also very important to have this discussion with your physician,” says Dr. Namazy. “A shared decision-making process can make sure that you get all the facts and safety data as you proceed.”

Uncontrolled or severe asthma may also impair the baby’s ability to get the oxygen they need to grow properly. This can lead to complications such as include low birth weight, preterm birth or small size for their gestational age.

Another common issue for pregnant women is shortness of breath. This may be due to a condition called dyspnea during pregnancy, which affects about 50% of women in their second and third trimesters.

“During pregnancy, the mother’s body undergoes hormonal changes as her baby develops,” says Dr. Namazy. “These changes could lead to hyperventilation, or the mechanical changes to the body as the baby grows can lead to shortness of breath symptoms.”

Pregnant women are at an increased risk of upper respiratory tract infections due to changes in antiviral immunology. These can range from the common cold to flu, COVID-19 and pneumonia.

“Some of these can be very dangerous conditions that can affect patients both pregnant and non-pregnant,” says Dr. Namazy. “There is a great deal of data looking at the safety of COVID-19 vaccines as well as influenza vaccines and their safety during pregnancy, and they are recommended during pregnancy.”

Treatment depends on the type of infection and symptom relief, but if antibiotics are needed, your doctor can advise you on which are safe to use.

Another condition, pregnancy rhinitis, can mimic allergy systems such as congestion, sneezing and stuffy nose; however, it is caused by hormonal changes and increased blood volume. It affects about 20-30% of expectant mothers, typically starting in the second trimester and resolving after delivery.

Pregnancy rhinitis doesn’t pose a risk for the baby, but can certainly affect the mother’s sleep and quality of life. It is usually managed with saline nasal sprays or decongestants if needed.

Dr. Namazy emphasizes the importance of forming a partnership with your physician before you start trying to conceive.

“Start early during the family planning stages so you can review not only your chronic medical conditions, but also the medications you're taking and any other activities such as smoking,” says Dr. Namazy. “We want to make sure that mom is healthy and happy during pregnancy and sleeping well, and that we all lead to good outcomes.”

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