Presentations to review management of pulmonary disease during pregnancy

Stephanie M. Levine, MD, FCCP
Stephanie M. Levine, MD, FCCP

Both pregnancy and pulmonary disorders are common, but the combination can be particularly difficult to manage. Many of the normal physiologic changes seen during pregnancy can have dramatic effects on pulmonary disease and vice versa.

“Pulmonary vascular diseases can be affected by the normal physiologic changes of pregnancy more severely than during nonpregnant states,” said Stephanie M. Levine, MD, FCCP, professor of pulmonary and critical care medicine, University of Texas Health Science Center at San Antonio. “Pulmonary hypertension in pregnancy is associated with significant morbidity and mortality due to worsening of the condition due to the normal cardiovascular physiologic changes that we see during pregnancy.”

Dr. Levine will chair a panel discussion, From Conception to Birth: Management of Pulmonary Disease in Pregnancy, on Monday, October 17, from 11:00 AM – 12:00 PM CT in Room 104BC. All of the topics are directly related to, or can lead to, pulmonary vascular disease.

Deborah Levine, MD, MS, FCCP, University of Texas Health Sciences Center at San Antonio, will focus on pulmonary hypertension, a diagnosis that may predate pregnancy or become apparent during pregnancy. Cardiac output normally increases during pregnancy with a corresponding reduction in pulmonary vascular resistance, Dr. Stephanie Levine explained. Individuals with pulmonary hypertension have high pulmonary vascular resistance. That results in extremely high cardiac output trying to push through a reduced and compromised vascular circulation, leading to increased morbidity and mortality.

“We strongly counsel our patients with pulmonary hypertension not to become pregnant or to be aware of the significant complications associated with pregnancy in this population,” Dr. Levine said. “The first weeks to month post-delivery can be the most tenuous for the mother because you have more fluid that has been in the peripheral tissues coming back into the bloodstream, putting even more strain on the heart. Even after that immediate period has passed, you will still have PH to manage.”

Lisa Moores, MD, FCCP, associate dean for student affairs at the Uniformed Services University of the Health Sciences’ F. Edward Hebert School of Medicine, will explore the latest developments in evaluating and managing venous thromboembolism (VTE) during pregnancy. Pregnancy dramatically increases the risk of both deep venous thrombosis (DVT) and pulmonary embolism (PE), due to hypercoagulability, among other factors, and clinicians should be current on the latest management recommendations.

For patients who are receiving anticoagulation for DVT or PE during pregnancy, treatment should be continued for a period after delivery. And, the appearance of DVT or PE during one pregnancy can increase the risk of developing either or both during a subsequent pregnancy, a risk that both patient and clinician need to recognize.  

Sleep-disordered breathing is another common complication of pregnancy. Nancy Collop, MD, Master FCCP, professor of pulmonary, allergy, critical care, and sleep medicine and director of the Emory Sleep Center at Emory University, will discuss the latest findings in assessment and management.

Sleep-disordered breathing may improve with normal physiologic changes after delivery, Dr. Levine said, but follow-up will almost certainly be needed.

“Pregnancy is something most of us experience in our pulmonary and critical care practices regardless of setting,” she said. “That makes it particularly important to refresh your knowledge of the new developments in these common complications and just how closely they must be followed and managed. The risk for venous thromboembolism and sleep-disordered breathing, in particular, increase during pregnancy, and any preexisting conditions can worsen without any clear warning signs.”