The consensus of medical opinion is that PH and pregnancy is very dangerous. The life of the mum and baby are put at great risk. Women with any serious illnesses must face several questions before they decide to have children, including whether the pregnancy and delivery could be life-threatening. Pregnancy can really take its toll on a woman’s body. For example, the heart rate speeds up and the immune system doesn’t work quite as well. For a woman whose body already has to deal with a severe illness, pregnancy can actually have catastrophic consequences.

It seems really unfair that PH is a disease that often is seen in women of child-bearing age as unfortunately this makes pregnancy a quite common issue. The risk of pregnancy-related death in women with PH is substantial (reported to be as high as 30 to 50%). For this reason alone therefore, pregnancy does not offer very good prospects for women with PH. In addition some of the drugs commonly used to treat PH (e.g. warfarin) can be harmful to the developing fetus. Because of this twofold risk to both the patient and the fetus, use of some form of birth control to avoid pregnancy is strongly advised in women of childbearing age with PH.

Which form of contraception to use?

There are no published guidelines for birth control use in PH, and there is no consensus regarding the best form of birth control. Birth control must be discussed with you PH team, don’t be embarrassed or avoid the issue, it is too important. Below is a brief résumé of some of the important factors to consider:

Why do I need to use contraception?

PH specialists strongly advise you against becoming pregnant when you have pulmonary hypertension as pregnancy can make the disease worse. Sadly you run a high risk of dying if you become pregnant.

If your pulmonary hypertension is secondary to another medical problem, such as systemic lupus, it is possible that the other problem may also reduce your chances of having a healthy baby.

Some of the medication you may take can also affect a developing baby. If you do become pregnant it is important for you to be seen by your specialist team as soon as possible, so they can discuss the options for treatment with you. Many doctors would advise a permanent method of contraception because of concerns about your health if you became pregnant. This is one of the few conditions when sterilization is offered to a woman who has not had any children.

Can I take the oral contraceptive pill?

The combined pill (which is usually taken for 3 weeks out of every 4) should be avoided as it contains estrogen which is thought to actually make PH worse. The progesterone only pill (also known as the minipill) is probably not advised because it may make the risk of developing blood clots a little higher. It is also a method with a medium risk of failure.

For the complete information please download the pdf file at the top.