Chest Pain During Pregnancy: Causes, Treatment

Question: What causes chest pain during pregnancy?

Physiologic changes during pregnancy affect the heart, blood vessels, brain, kidneys and the blood system. The respiratory system is also affected by pregnancy, resulting in breathing changes and sometimes chest pain.

Though chest pain occurs more in the second and third trimester of pregnancy, it could occur at any time depending on the cause.

The truth is, chest discomfort during pregnancy happens for many reasons and most likely it is not a serious concern. However, new, severe or persistent chest pain should never be ignored.

In some women, it happens because of the chest compression by the growing baby. Your chest consists of different organs, including the heart and lungs. As your womb grows, it forces your diaphragm against your chest causing pressure and discomfort.

Other non-serious causes of chest pain during pregnancy are long-term stress, pregnancy hormones, muscle or joint pain around the ribs, and pain from breast enlargement that happen during pregnancy.

Having said that, it is important you are able to know when pain is getting worse. If you feel excruciating chest pain, chest tightness, or pain that makes it difficult to breathe, it is vital you see a doctor or go to the emergency room right away.

Serious causes of chest pain include infections (pneumonia), heart diseases, bronchial asthma, pulmonary embolism (blood clot in the lungs), heart attack, direct injury to your chest wall, and high blood pressure problems such as preeclampsia.
Acid reflux (heartburn) is also a very common cause of burning chest pain in pregnancy, but it is usually not dangerous. You can read more about heartburn in pregnancy from Cleveland Clinic and the UK NHS pregnancy heartburn page.

If you think your pain is persistent and affects your daily activity, you must see your doctor quickly. Here are five questions you must prepare to answer during your visit:

• Do you feel pain in the upper or lower part of your chest?

• Is chest pain in the middle, right or left side of the chest wall?

• Is pain sharp, dull, tight, or burning?

• Does pain get worse while lying down or at night?

• Does chest pain start after eating or when you walk or climb stairs?

This article explains the causes of chest pain during pregnancy and simple lifestyle modifications that will make you feel better. It does not replace an in-person assessment by your health-care provider.

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What causes chest pain during pregnancy?

Like already mentioned, chest pain happens due to physiological changes during pregnancy as well as medical problems that may need urgent care. Here are the reasons why they occur.

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1. Effect of progesterone hormone

Immediately after getting pregnant, there is a progesterone surge. This hormone can cause changes to your lower esophageal sphincter and result in acid reflux (heartburn).

The lower esophageal sphincter is at the inferior end of the esophagus, an 8 inches muscular tube that conveys food from your mouth to your stomach.

During pregnancy, progesterone relaxes the esophageal sphincter, and later the growing uterus also pushes up on the stomach. This makes it easier for stomach contents to move upward into the esophagus.

This can result in irritation and inflammation of the esophagus, causing a burning sensation (heartburn) in the lower part of the chest and the upper abdomen.

Pregnant women will experience this type of chest pain more at night, after eating or when lying down.

Heartburn in pregnancy is very common, and simple lifestyle changes plus medicines that are safe in pregnancy (such as antacids or some acid-reducing drugs) usually help. Always talk to your doctor or midwife before starting any medicine. For more detail, you can check the NHS advice on indigestion and heartburn in pregnancy or this Cleveland Clinic heartburn in pregnancy guide.

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2. Expanding chest wall

Another reason you may feel chest discomfort while pregnant is the pressure effect of your baby against the thoracic cavity.

Between your chest wall and abdomen is the diaphragm. As your baby grows, it compresses on the diaphragm and chest wall, reducing the chest ability to expand fully. This can cause a feeling of tightness or discomfort and may be felt on both sides, center, or on the left or right side.

You may also notice that you become short of breath more easily when you climb stairs or lie flat. If you feel symptoms are getting worse, or you are short of breath at rest, talk to your doctor for help.

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3. You are stressed up

It is normal for pregnant women to worry easily for the well being of their baby. If you get worked up emotionally or physically, it can have an impact on your health.

Anxiety and panic attacks can cause chest tightness, fast heartbeat, breathing fast, trembling and a feeling of “something bad is about to happen”. These symptoms can be very frightening but are not usually dangerous by themselves.

It is crucial you relieve yourself of stress. Talk to your doctor or a counselor for help, and let your care team know if you feel your mood or anxiety is getting worse.

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4. Infection affecting the lungs

Lobar pneumonia or lung infections are a common cause of chest pain. During pregnancy, changes in your immune system and lungs can increase your risk of some chest infections and make them more severe if not treated early.

If you have pneumonia during pregnancy, you can expect to have chest pain. Other symptoms of pneumonia are vomiting, fever, chills, difficulty in breathing (or breathing faster than usual), worsening cough, and body weakness.

If you already have these symptoms, it is likely you have a chest infection. So, see a doctor urgently.

Blood tests, sputum test or a chest x-ray with proper shielding may be requested by your doctor to make the diagnosis. If you have pneumonia and chest pain, painkillers, antibiotics that are safe in pregnancy, and sometimes oxygen will be prescribed.

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5. Heart attack (rare but serious)

A heart attack is one possible cause of chest pain in men and women. If you are pregnant and have a heavy, squeezing or sharp pain in the middle of the chest or left side, it could be a heart attack. If pain radiates to the back, neck, jaw or arm, and you feel sweaty, sick, or find it difficult to breathe, then you need urgent help.

Acute heart attack during pregnancy and shortly after delivery is rare, but it is more common than in women of the same age who are not pregnant. Studies suggest it happens in about 1 in 10,000–16,000 deliveries.

Therefore, if you have central chest pain while pregnant, it is still more likely due to other causes such as heartburn or muscle pain rather than a heart attack. However, because a heart attack can be life-threatening, any sudden, severe chest pain or chest pain with shortness of breath should be treated as an emergency.

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6. Asthmatic attack

Bronchial asthma is a long-term condition that causes chest tightness, pain, wheezing and difficulty in breathing.

If you’ve been diagnosed with asthma before getting pregnant, then it is possible you will experience an attack while pregnant.

Here’s the thing; bronchial asthma may get worse, improve or remain stable during pregnancy. Women who had severe attacks before pregnancy may experience severe symptoms during pregnancy.

Trigger factors vary among women, but commonly chest pain and tightness are triggered by the flu, cold, allergies, cigarette smoke, exercise, perfumes sprays, dust and emotional upset.

If you have asthma during pregnancy, you can have chest pain or tightness. Do not stop your inhalers without talking to your doctor. See your doctor promptly if you are using your reliever inhaler more often, waking at night with symptoms, or finding it hard to speak in full sentences.

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7. Hypertension complication (preeclampsia)

During pregnancy, it is possible to develop new-onset high blood pressure after the 20th week. This results from placental changes and it is more likely to occur in first-time moms, twin pregnancies, women who get pregnant after 40 years, women with chronic hypertension, kidney disease or diabetes, and women with a history of preeclampsia.

In severe cases of high blood pressure in pregnancy, you may experience chest pain or shortness of breath due to the accumulation of fluid in your lungs (pulmonary edema), or due to strain on your heart.

Other symptoms of severe preeclampsia are severe headaches, changes in vision (blurry vision, flashing lights), upper abdominal discomfort (especially under the right ribs), nausea or vomiting, sudden swelling of the face, hands or feet, and convulsions (eclampsia).

These are emergency warning signs. If you have them, you should go to the hospital immediately. You can read more about warning signs and long-term risks on Mayo Clinic’s preeclampsia page, Cleveland Clinic’s preeclampsia overview and the Preeclampsia Foundation “Signs and Symptoms” guide.

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8. Pulmonary embolism (blood clot in the lungs)

Pulmonary embolism is a serious condition where a blood clot travels to the lungs and blocks blood flow. Pregnancy and the weeks after delivery increase the risk of deep vein thrombosis (DVT) and pulmonary embolism.

Symptoms include sudden unexplained shortness of breath, sharp chest pain that worsens with deep breaths, coughing up blood, fast heartbeat, feeling very unwell or collapsing. This is a medical emergency, and you should seek help immediately or call your local emergency number.

For more about blood clots in pregnancy and after birth, you can read the Royal College of Obstetricians and Gynaecologists patient leaflet on venous thrombosis and this general overview of pulmonary embolism from Cleveland Clinic.

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How to stop chest pain while pregnant

If you have mild or moderate chest pain that has already been checked by a doctor, there are some simple tips to follow and improve your symptoms. If pain is new, severe or persists, see your healthcare provider for help.

• Don’t eat too late before going to bed.

• Break your meals and eat small portions at intervals.

• Avoid very spicy, fried or fatty foods if they worsen your symptoms.

• Always lie on your sides in late pregnancy rather than flat on your back.

• Avoid going to bed minutes after eating; wait at least 2–3 hours.

• Reduce your stress level or see a counselor for help.

• Avoid smoking, caffeinated drinks, and fatty foods.

• If you are asthmatic, stay away from trigger factors (perfumes, dust, cold, cigarette smoke, etc).

• Elevate your head and upper body while you sleep. Using extra pillows or raising the head of the bed may improve symptoms.

• Only take painkillers or heartburn medicines recommended by your doctor or midwife as safe in pregnancy.

• Consult your doctor for expert care if the chest pain keeps coming back or is getting worse.

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When to see a doctor?

If you develop any of the below-listed symptoms, quickly see your doctor, midwife or go to the nearest emergency unit:

• High body temperature (fever).

• Vomiting that you cannot keep down.

• Chest pain, pressure, or tightness that is severe or does not go away.

• Severe wheezing and chest tightness.

• A cough that is getting worse or coughing up blood.

• Difficulty in breathing, breathing very fast, or feeling like you cannot get air.

• Sudden swelling of your face, hands or feet.

• Severe headache, vision changes, or confusion.

• Abdominal pain, especially under the right ribs.

• Decreased movement of your baby.

• Fainting, feeling very weak, or a sense that “something is very wrong”.

Do not drive yourself to the hospital if you feel very unwell. Ask someone to take you or call an ambulance if available.

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FREQUENTLY ASKED QUESTIONS

What causes chest pain during pregnancy while lying down?

Chest pain while lying down commonly happens because of gastroesophageal reflux disease (GERD) that irritates the esophageal lining. This can be prevented by avoiding late night eating, reducing stress, and waiting a while after eating before lying down. Sleeping slightly propped up on pillows may also help.

However, if chest pain when lying down is severe, associated with shortness of breath, rapid heartbeat, or if you feel unwell, you should seek urgent medical care because more serious heart or lung problems can also cause these symptoms.

What causes upper back and chest pain during pregnancy?

Chest pain may radiate to other parts of your body, including the back. Heart attack, pulmonary embolism, peptic ulcer disease, acid reflux, gallbladder disease, muscle strain around the ribs, and direct chest trauma can cause this type of pain.

Because some of these causes are serious, always speak with your doctor or midwife if you have persistent chest or upper back pain during pregnancy, especially if it is new, severe, or associated with shortness of breath or feeling unwell.