Across America a woman’s right to terminate an unwanted pregnancy is under threat. Without diving into politics or religion I want to impress on the PAH community why this may spell disaster for our PAH patients.
The Supreme Court is on the verge of reversing half a century of legal precedent that has protected a woman’s right to choose. At the same time, several states have passed or are about to pass laws that criminalize abortion under any circumstances. Even states that preserve access to pregnancy termination in the case that the mother’s life is in jeopardy are creating new hoops that will further jeopardize maternal health. Who will be deciding that the mother’s life is at risk? In parallel with greatly reduced or eliminated access to abortion, access to birth control is under attack at a state and federal level.
PAH is a disease disproportionately of young women who have the potential to get pregnant. Sex is part of life and even PAH patients have sex. Even the best methods of birth control are not 100% reliable. In my career I have taken care of many young women who have become pregnant despite IUDs, oral contraceptive pills and condom use. Pregnancy is a life-threatening condition for PAH patients. Published mortality can be as high as 50-80% for women with severe PAH.
Many women with PAH come to learn of their diagnosis during or shortly after pregnancy. As pregnancy advances, the mother’s blood volume increases by 50%. This increased blood volume puts a huge stress on the right ventricle of a PAH patient. As a result, PAH patients begin to deteriorate as the second trimester begins. By the end of the second trimester, PAH patients with advanced disease become markedly worse. The period of greatest risk for death is towards the end of the third trimester, during delivery and in the first few days after delivery.
Many of our PAH medications are not proven to be safe in pregnancy and one class—endothelin receptor antagonists (Letairis, Tracleer, Opsumit) cause birth defects and are absolutely contraindicated in pregnancy. As a result, endothelin receptor antogonists (ERA) must be stopped in pregnancy. This requirement to stop ERA therapy can lead to worsening PAH separate from the stresses of pregnancy.
As a PAH specialist I treat hundreds of young women who would like nothing more than to safely carry a pregnancy to term. I work with them to understand the importance of birth control as part of their PAH care plan. Despite our best efforts together, pregnancies still happen. The state’s interference with my ability to do what is right for the patient is unacceptable. How many young women with PAH will have to die as a result of these laws.
Would these laws be considered if a man’s life were at risk as a result of pregnancy? The PAH community, the Pulmonary Hypertension Associate and all people of conscience must raise their voice and be heard. Keep government out of the doctor patient relationship. We must preserve unrestricted access to birth control and pregnancy termination to keep our PAH patients healthy.