pneumonia in pregnancy

Overview

Pneumonia is an infection in the lungs that causes the small air sacs to fill with fluid or pus. It makes it harder for your body to get the oxygen it needs. During pregnancy, this can be more serious because pregnancy changes both your immune system and how your lungs work.

Pneumonia is not a common pregnancy complication, but it is one of the more serious infections that can happen. It affects roughly 1 in every 1,000 pregnancies, so most pregnant people will never experience it.

Anyone who is pregnant can get pneumonia, but you are more likely to develop it if you smoke, have asthma, diabetes, or anemia, or have a weakened immune system. Cases often appear in the second half of pregnancy.

Symptoms

Common symptoms

• A cough that may bring up mucus or phlegm
• Fever and chills
• Fast breathing or feeling short of breath
• Chest pain, especially when coughing or breathing in deeply
• Feeling very tired or having body aches

Symptoms in children

• Breathing very fast
• Making a grunting sound with each breath
• Flaring of the nostrils
• Being unusually drowsy or irritable
• Refusing to drink fluids

Symptoms in older adults

• Confusion or unusual sleepiness
• Dizziness or falls
• Lower than normal body temperature
• A cough that may be mild or not present
• Weakness and loss of appetite

Causes

Main causes

• Bacteria — this is the most common cause in adults
• Viruses — such as flu, COVID-19, and respiratory syncytial virus (RSV)
• Fungi — less common and more likely in people with weakened immune systems

Risk factors

• Smoking or being around smoke
• Asthma or another chronic lung condition
• Diabetes
• Anemia
• HIV or another condition that weakens immunity
• Not having recommended vaccines
• Living with someone who is sick or being in crowded places often

When to see a doctor

See a doctor urgently if:

• If you have a fever with a cough, shortness of breath, or painful breathing, call your doctor the same day.
• If your cough produces phlegm that is yellow, green, or tinged with blood, seek same-day care.
• If you feel faint, have chest pain, or are struggling to breathe, go to urgent care or contact your maternity unit immediately.

Book a routine appointment if:

• A mild cough that lasts more than a week
• A low-grade fever below 38°C (100.4°F) that comes and goes
• Unusual tiredness or decreased appetite for a few days
• A lingering cold that feels worse instead of better

Diagnosis

Your doctor will ask about your symptoms, listen to your lungs with a stethoscope, and check the oxygen level in your blood. If pneumonia is suspected, they may order tests to confirm the infection and find the cause.

Tests that may be done

• Chest X-ray — with a lead shield, this is considered safe and important during pregnancy
• Pulse oximetry — a small clip on your finger that measures the oxygen in your blood
• Blood tests — to look for signs of infection and to check your overall health
• Sputum sample — a sample of the mucus you cough up, sent to the lab to identify the germ

What to expect at your appointment

Your healthcare team will explain each test and why it is needed. They will also monitor your baby, often with a fetal heart rate check. In many cases, you can have these tests in the clinic or maternity unit and go home the same day.

Treatment

Most pregnant people with pneumonia need medical treatment, and many can be treated at home with rest and close follow-up. If you have low oxygen levels, trouble breathing, or are at risk of early labour, your doctor may recommend hospital care.

Self-care at home

• Rest as much as possible and avoid heavy lifting or strenuous activity
• Drink plenty of fluids such as water and warm soups to keep the mucus loose
• Eat small meals often if a full stomach makes breathing uncomfortable
• Use a cool-mist humidifier in your room to soothe your cough
• Avoid smoke, strong fumes, and crowded places

Medical treatments

Treatment depends on whether the pneumonia is caused by bacteria, a virus, or something else. If bacteria are the cause, you will be prescribed an antibiotic that is safe during pregnancy. If a virus is the cause, you may receive supportive care, such as oxygen, fluids, and fever control, and in some cases an antiviral medicine. In more severe cases, you may be admitted to the hospital for oxygen therapy and intravenous fluids. Always take any medication exactly as prescribed and do not take over-the-counter products without asking your doctor.

Living with this condition

Recovery from pneumonia takes time. You may start to feel better within about a week, but the cough and tiredness can last a month or more. Go back to normal activities slowly, and keep paying attention to your breathing. Continue prenatal check-ups so your care team can also check on your baby.

Lifestyle tips

• Sleep with an extra pillow to make breathing easier at night
• Take your medicine exactly as directed and finish the full course
• Wash your hands often and cough into a tissue or your elbow
• Keep all follow-up appointments with your doctor
• Ask family or friends for help with chores, meals, and childcare

Diet and exercise

Eat a balanced diet with fruits, vegetables, lean proteins, and whole grains to help your body fight the infection. Avoid vigorous exercise until your fever is gone and you feel stronger. Gentle walking is fine and can help during recovery.

Mental health and emotional wellbeing

Being seriously ill during pregnancy is stressful and can bring up anxiety, fear, or low mood. It is completely understandable. Talk to your doctor or midwife about how you feel — they can refer you to a counsellor or mental health support service that specialises in pregnancy.

Prevention

You cannot always prevent pneumonia, but you can reduce your risk by keeping your vaccinations up to date, washing your hands regularly, avoiding smoke, and staying away from people who are sick.

Vaccines

Flu and COVID-19 vaccines are recommended for everyone who is pregnant and can prevent viral pneumonia. Depending on your health, your doctor may also advise a vaccine against the bacteria that commonly cause pneumonia. Ask your doctor which vaccines are right for you.

Screening programmes

There is no routine screening test for pneumonia. Instead, your healthcare team will review your risk factors, such as asthma or diabetes, at your antenatal appointments and may recommend extra monitoring if you are at higher risk.

Complications

If left untreated

• Pneumonia can spread further into the lungs and lead to respiratory failure, where your body cannot get enough oxygen
• It can cause sepsis, a severe and life-threatening whole-body infection
• It can trigger early labour or lead to a low birth weight baby
• In very rare cases, it can become life-threatening for both you and your baby

Long-term outlook

The outlook is very good with early treatment. Most pregnant people with pneumonia recover fully and go on to deliver healthy babies at full term. Even those who need hospital care usually improve within days and return home within a week or two. It may take a few weeks to get your energy back, but you will be guided and supported by your healthcare team every step of the way.

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