Pregnancy is often associated with aches and pains especially in the second half but some pains can be a cause for concern. Most women are accustomed to abdominal and pelvic pain, headaches and aching legs but chest pain during pregnancy elicits the thought of serious life-threatening ailments. This is usually not the case. Chest pain is actually common during pregnancy and even afterwards, and is often not serious despite the level of pain and discomfort. However, there are several life-threatening conditions that can occur in pregnancy which may present with chest pain.
The most common causes of chest pain during and after pregnancy are often not serious in that it will not be life-threatening. It can be extremely uncomfortable and should be treated to minimize the burden on the mother. Many of these conditions will ease or even resolve a few months after childbirth.
Heartburn is a common symptom in pregnancy and even for a short period thereafter. It is the result of acid reflux and is more correctly known as gastroesophageal reflux disease (GERD). Here the acidic stomach contents moves backwards into the esophagus. Although GERD is common in both males and females, the condition tends to worsen during pregnancy. It is largely due to the pressure on the stomach as the uterus increases in size due to the growing fetus. The change in hormone levels during pregnancy may also play a role.
Indigestion is a collection of symptoms like abdominal discomfort, a feeling of fullness, bloating and nausea. We all experience indigestion several times in life. It is usually associated with overeating, fatty and spicy meals, caffeine or alcohol consumption and when anxious. Indigestion is often referred to as an ‘upset stomach’ and is common in pregnancy. The growing fetus may block the movement of food in the intestine and further contribute to acid reflux as well.
The pregnancy hormonal change causes the breasts to enlarge and prepare for milk production to nourish the baby. These breast changes can cause tenderness and pain in the breasts and chest wall. Furthermore the increased size and weight of the breasts strains the muscles and joints of the chest wall. Breastfeeding increases the chances of a breast infection (mastitis) which can also cause chest pain. In these cases the chest pain is superficial and felt on the chest wall rather than deeper in the chest.
Anxiety is common in pregnancy, whether it is related to the pregnancy and childbirth itself or from other causes. The changes in hormone levels affects the moods and many pregnant women experience palpitations and shortness of breath during anxiety. These sensations are sometimes mistaken for chest pains. However, chest pain with anxiety may also occur but it is not usually due to cardiac (heart) conditions as is often thought. The pain tends to subside once the expectant mother calms down.
The growing fetus increases the pressure not only within the abdomen but also within the chest cavity. The diaphragm (main respiratory muscle) may not have the same degree of movement and often the accessory respiratory muscles on the chest is used for breathing. This can cause muscle pain when it has to be sustained for long periods. Ultimately there is some widening of the rib cage which can result in pressure and pain at the costal cartilages which lies between the ribs and sternum (breastbone).
Most of the serious causes of chest pain during pregnancy relate to cardiovascular diseases. With women able to now have children at a later age, some of these conditions are very likely to arise compared to being relatively uncommon in the past. A history of cigarette smoking, hypertension and family history of heart disease increase the risk of cardiovascular conditions occurring during pregnancy.
Many pregnant women who have mild asthma or who had asthma earlier in life but were relatively symptom-free before pregnancy will find that their asthma recurs or worsens during pregnancy. The tightness in the chest that is characteristic of asthmatic attacks is sometimes thought to be pain. But chest pain can occur in asthma.
A heart attack is very possible during pregnancy especially if the mother has severe coronary artery disease. Mothers who are/were smokers, have diabetes and are older than 40 are at a greater risk. Even if a heart attack does not occur, the chest pain can occur with angina pectoris. This is a cardiac chest pain where the blood flow to the heart is momentarily reduced without death of heart muscle like in a heart attack.
Deep Vein Thrombosis
Being sedentary coupled with changes in peripheral circulation during pregnancy can increase the risk of deep vein thrombosis (DVT). When the clot is isolated to the leg then it causes symptoms like pain and swelling. But if it dislodges, travels through the circulation to the tors0 then it can block vital blood vessels. DVT can lead to pulmonary embolism which causes chest pain and is fatal if left untreated.
Sudden Arrhythmic Death Syndrome
It is a little known condition but sudden arrhythmic death syndrome (SADS) is a risk for pregnant women. The heart beat become erratic and leads to failure of the heart to function effectively. The exact link between SADS and pregnancy is unclear but it is believed that SADS may arise with the physiologic strain that pregnancy puts on the body.
This is another cardiac condition that is not well known. It is a condition where the heart muscle becomes diseased and weakened. Peripartum cardiomyopathy can become evident up to a month before childbirth or even up to 5 months after delivery. It is believed that a viral infection of the heart muscle may be the underlying cause.
An aortic dissection is a condition where a tear occurs in wall of the largest artery of the body, the aorta. Blood accumulates between the layers of the aorta wall and can eventually lead to a rupture of the artery. There is a number of predisposing factors for the development of an aortic dissection and pregnancy can further increase the risk. It is more likely to occur in women over the age of 40.
Congenital Heart Disease
Some heart defects that may have been present since birth may not pose a significant problem to a person. But with the stress placed on the body and specifically the heart during pregnancy, these heart defects can have serious complications. Women with congenital heart defects have to be cautious during pregnancy and must be monitored closely.