Pectus Excavatum and Pregnancy: Breathing, Birth, Nuss Bar

Search for pectus excavatum and pregnancy and you’ll mostly find one reassuring line, like Cleveland Clinic’s: people with pectus excavatum “can carry a normal pregnancy to term.” For most women, that’s probably true. But it rests on a handful of case reports, and the women in them who struggled had severe chests or symptoms, mostly in the last three months.

Below is every published pregnancy with pectus excavatum (PE) I could find, what pregnancy does to your heart and lungs, what’s known about a Nuss bar (the curved steel bar a surgeon places behind the breastbone to push it forward), and what to tell your obstetrician and anaesthetist.

A word on who’s writing. I had pectus excavatum, diagnosed at 15, and corrected it without surgery over about three years. The change was visible and measurable, but not complete. I’m not a doctor, and I’m a man, so none of this is my experience. It’s the published research. For breasts, symptoms and options, see pectus excavatum in women.

Can you have a normal pregnancy with pectus excavatum?

Probably, if your chest is mild and you have no symptoms. That’s my reading, not a measured fact: I found no study that followed a large group of pregnant women with PE.

PE affects about 1 to 8 in every 1,000 people and is more common in boys, according to Cleveland Clinic. The published pregnancy record is small: 17 women across seven papers, all in the table below. Fourteen of the 17 are described as having successful pregnancies, five of them with a Nuss bar in place.

The ones who struggled had severe chests or symptoms, and their trouble came late. So having PE matters less than how severe yours is and whether it already causes symptoms.

Severity is usually measured with the Haller index, a ratio from a chest scan: the inside width of your chest divided by the shortest gap between your breastbone and spine. About 2.5 is average for a chest without pectus excavatum, and higher means deeper. No scan? Your symptoms are what you can describe today.

What pregnancy does to your heart and lungs

These figures come from two reviews of healthy pregnancy, Soma-Pillay and colleagues for the heart and blood and LoMauro and Aliverti for breathing. Neither includes women with PE. Cardiac output is the amount of blood your heart pumps each minute.

What changes	By how much	When
Cardiac output	Up 20% by 8 weeks, about 40% overall	Highest at 20 to 28 weeks
Plasma, the fluid part of blood	Up about 50%	Mostly by 34 weeks
Lying on your back	Can cut cardiac output by 25%	Late in pregnancy
Labour	Cardiac output up 15%, then 50%	First stage, then pushing
Just after the birth	Cardiac output up 60 to 80%	Back to pre-labour levels within about an hour
Diaphragm, the main breathing muscle	Rises about 5 cm	During pregnancy
Lower ribcage	The angle below the breastbone widens from 68.5° to 103.5°	By the end of pregnancy
Breathlessness	Reported by 70% of healthy pregnant women	Often from the first trimester

Two normal changes can sound alarming. A heart murmur, an extra whooshing sound through a stethoscope, is heard in over 90% of pregnant women, and occasional extra beats can be normal. Breathlessness is so common that normal and abnormal are hard to tell apart.

Now the PE part, which is my interpretation, not a study finding. In the most severe chests in the case reports, the breastbone pressed on the heart or the main vein into it. Pregnancy asks that heart to pump about 40% more while the diaphragm pushes up, so a deep chest has less room. The busiest times are the third trimester, labour and the hour after birth, and the third trimester is when the reported PE symptoms showed up.

Breathlessness on the stairs is normal in pregnancy. Breathlessness at rest or lying down, or a racing heart with dizziness, is worth raising, sometimes urgently (see the list near the end). If you had symptoms before pregnancy, pectus excavatum symptoms helps you describe them.

Every published pregnancy with pectus excavatum I could find

That’s the whole record I found, mostly single cases.

Study	Women	Chest or bar	What happened	Delivery
Fonkalsrud 2004	9	PE, before repair, in one surgeon’s 33-year series of female patients	Successful pregnancies, and all nine had severe breathlessness in the last three months	Not reported
Chang 2011, Taipei	2	Nuss bar in place	Both delivered successfully before the bar came out	Not in the abstract
Jaroszewski 2015, Mayo Clinic Arizona	2	Nuss bars in place	One carried a single baby and one carried twins to term	Not in the abstract
Frongia 2024, Germany	1	Haller index 5.4, one Nuss bar	Two pregnancies before repair were hard. Pregnant about six months after surgery, she found this one “much more tolerable”	Vaginal, at term. Bar out at 26 months; her next birth was also vaginal
Bianco 2021	1	Rare and extreme: Haller index 14, with the main vein into the heart and the heart’s right upper chamber compressed	A deep vein thrombosis (a clot in a deep vein) reaching the thigh. Twin pregnancy lost at 21 weeks, probably from the clot, the authors say. They couldn’t show the chest caused it	Not applicable
Shimizu 2021, Japan	1	PE not known until the operation	A labour-delaying drug from 31 to 35 weeks, then preterm labour at 36 weeks with the baby breech. Fluid on the lungs after the operation, then recovery. The authors suggest PE contributed	By operation; no more detail in the abstract
Ferraz 2023	1	Severe PE pressing on the right side of the heart, found while checking palpitations	She became pregnant and follow-up was delayed	Outcome not reported

What the table can’t tell you is how often PE causes trouble in pregnancy. There’s no denominator: Fonkalsrud’s nine later needed surgery, and nobody counted the women with PE whose pregnancies went easily. Case reports also tend to get written when something unusual happens.

Pregnant with a Nuss bar, or planning surgery

Five women in three case reports, from 2011, 2015 and 2024, gave birth with the bar still in place, one of them to twins. When Frongia’s team reviewed the four earlier cases, one woman had no symptoms, two had chest pain and one had mild breathlessness on effort, all in the third trimester. None of the reports describes the bar moving, though five women can’t give you a rate of anything.

Frongia’s team speculate that the bar may limit how much the ribcage widens, which in theory could put forward or upward pressure on the bar. Their own patient’s pregnancy was uneventful. Their conclusion: no evidence that pregnancy should be avoided after a bar goes in, and more objective data needed.

If you’re planning both:

• Surgery and removal wait. Bar surgery and removal are planned operations, and Frongia’s team, citing ACOG (the American College of Obstetricians and Gynecologists), say both should wait until after delivery. ACOG advises an obstetric consultation before non-obstetric surgery in pregnancy.
• Waiting for removal costs time. The bar usually stays two to three years, so putting pregnancy off until it’s out means waiting at least two years. Frongia’s team call that sacrificing two years of reproductive capacity. It’s a trade-off for you and your surgeon, not a rule. See Nuss bar removal.

A bar also changes emergency care: CPR needs more force, defibrillator pads go front and back, and MRI rules differ. Details are in my Nuss procedure guide. Tell your maternity team too.

Delivery, epidurals and anaesthesia

Nothing I found in the published research says PE needs a caesarean (a C-section, delivering the baby through a cut in the abdomen). The closest guidance, for heart disease, doesn’t mention PE. The European Society of Cardiology’s 2025 guidelines on heart disease in pregnancy say a planned caesarean gives no advantage for the mother over a planned vaginal delivery, and keep caesareans for obstetric reasons and a few specific heart conditions. Your obstetric team decides on the usual grounds. In the table, only Frongia’s case reports a vaginal birth, twice.

An epidural is pain relief through a thin tube in your lower back, placed by an anaesthetist (anesthesiologist in the US), the doctor in charge of pain relief. One NHS hospital’s epidural leaflet says you’ll either sit on the side of the bed or lie on your side for it.

Position matters for one reason. A 19-year-old man with severe PE, not pregnant and already booked for chest repair, fainted and went into a dangerous heart rhythm while bending forward for an epidural. Doctors found no cause other than heart compression. He later recalled dizzy spells tying his shoelaces. It’s one rare case, and it doesn’t make epidurals risky in PE. But if you get dizzy or faint when you bend forward, tell your anaesthetist before an epidural. More in pectus excavatum and heart problems.

Some hospitals refer heart, lung or spine problems to an antenatal anaesthetic clinic, a meeting with an anaesthetist before labour. The Scottish and Australian referral lists I read don’t mention pectus, so ask whether you need one, especially with a severe chest, symptoms or a bar.

What to tell your obstetrician and anaesthetist

Take this to your next appointment, and again to the anaesthetist:

• that you have pectus excavatum (or carinatum), how severe it is, and your Haller index if you know it
• any heart or lung test results, such as an echocardiogram (an ultrasound of the heart), lung function tests or an exercise test
• your symptoms and when they happen: on effort, at rest, lying down or at night
• whether you get dizzy or faint when you bend forward
• if you have a Nuss bar: when it went in, how many bars, steel or titanium, and your surgeon’s contact details
• any metal allergy
• signs of Marfan or Ehlers-Danlos syndrome (connective tissue conditions linked with PE), or whether a doctor has raised either
• any vacuum bell or brace you use

Exercise, sleep and scans while pregnant

Exercise. ACOG encourages physical activity in pregnancy for women without obstetric or medical complications. The NHS suggests 150 minutes of moderate activity a week plus two strength sessions, no fall-risk or impact sports or scuba diving, and not lying flat on your back for more than a few minutes later in pregnancy. With heart or lung limits, ask your team before you start or carry on. I found no study of exercise in pregnancy with PE.

Sleep. The NHS says going to sleep on your back after 28 weeks can increase the risk of stillbirth, and that it’s safest to fall asleep on your side, left or right. That’s for every pregnancy, whatever your chest.

Scans. Ultrasound and MRI come first in pregnancy, but ACOG says X-ray and CT doses are, with few exceptions, much lower than those linked to harm to the baby, so a needed scan shouldn’t be withheld. In my reading, a scan just to measure your dip can wait until after the birth. Check with your team.

Marfan syndrome. If you have it, or a doctor suspects it, the Marfan Foundation advises a cardiologist’s echocardiogram before pregnancy to check your aorta, the main artery leaving the heart. More in Marfan syndrome and pectus excavatum.

Vacuum bell and braces during pregnancy

I found no study of a vacuum bell or brace in pregnancy or while breastfeeding, so nobody knows.

The product page for my own vacuum bell says not to use it without speaking to your doctor first if you’re pregnant, on the same list as clotting disorders, heart conditions and chest surgery in the last six months. My carinatum and rib flare brace pages ask you to speak to your doctor before wearing one if you’re pregnant. Who shouldn’t use a bell at all is in vacuum bell therapy.

If your chest sticks out (pectus carinatum)

Pectus carinatum, where the breastbone pushes outward, has even less pregnancy research: I found none. Fonkalsrud’s series included 21 female patients with carinatum, but the abstract gives no pregnancy data for them. That means unknown, not a problem and not a green light. If you wear a brace, speak to your doctor before you carry on in pregnancy. The basics are in what pectus carinatum is.

Breasts and breastfeeding

Breasts change in pregnancy whatever your chest shape. An NHS hospital leaflet lists tenderness, size and shape changes, heaviness and darker skin around the nipple, and colostrum (first milk) can appear from about 16 weeks. If your bra stops sitting right, see bras for pectus excavatum.

On breastfeeding, I found no peer-reviewed study either way, with or without a bar. Some clinic and implant-maker pages say PE doesn’t affect it, citing no study. Not studied isn’t proof of no effect, or of a problem. If feeding is hard, tell your midwife about your chest.

After the birth

The heart’s biggest jump, right after delivery, settles within about an hour. Two things last much longer:

• Clot risk. Blood stays more prone to clotting from the first trimester until at least 12 weeks after the birth, Soma-Pillay’s review notes. A swollen, red or painful leg or arm is on the warning list below.
• The warning window. The CDC’s urgent warning signs apply for a year after delivery, not only in pregnancy.

Your lower ribcage is wider in the third trimester than after birth, and how fully it narrows again isn’t well measured. If your lower ribs stick out afterwards, see flared ribs.

I found no study on when to restart a bell or brace after a vaginal birth or a caesarean. Ask your doctor or midwife first.

When to get help now

Get medical help straight away, during pregnancy or in the year after it, if you have any of the CDC’s urgent maternal warning signs. These are the ones closest to the heart, lungs and clots (the full list is longer):

• trouble breathing
• chest pain or a fast-beating heart
• dizziness or fainting
• severe swelling, redness or pain in a leg or arm
• extreme swelling of your hands or face
• a headache that won’t go away
• overwhelming tiredness

With PE, add breathlessness at rest or lying down, and palpitations with dizziness. For chest pain, severe trouble breathing or fainting, call 911 (999 in the UK) or your local emergency number. A practical tip: say straight away that you’re pregnant or recently gave birth, that you have pectus excavatum, and whether you have a bar.

Will my baby have it?

It can run in families, though no specific gene has been found. Cleveland Clinic says 40% to 53% of people with PE have a family member with it. That describes families, not your baby’s odds, and I couldn’t find a figure for a mother passing it on. It’s rarely seen on a pregnancy scan. What to look for as your child grows is in sunken chest in babies and children.

Where to go from here

If your chest is mild and you feel fine, the reassurance fits you best. If it’s severe or you have symptoms, take the checklist to your team early, well before the third trimester.

Correcting the chest itself can wait until after the birth, with your doctor’s go-ahead. Structural change is measured in months and years either way. When you’re ready, my free 1-minute quiz gives you a sense of how deep your chest is and which non-surgical route fits your case.

Sources

1. Pectus Excavatum. Cleveland Clinic. Updated 2023 Aug 11 [cited 2026 Oct 20]. Read it
2. Soma-Pillay P, et al. Cardiovasc J Afr. 2016;27(2):89-94. Read it
3. LoMauro A, Aliverti A. Breathe. 2015;11(4):297-301. Read it
4. Fonkalsrud EW. Am J Surg. 2004;187(2):192-7. Read it
5. Chang PK, et al. Thorac Cardiovasc Surg. 2011;59(1):54-6. Read it
6. Jaroszewski DE, et al. Ann Thorac Surg. 2015;100(5):1877-8. Read it
7. Frongia G, et al. BMJ Case Rep. 2024;17(3):e255568. Read it
8. Bianco M, et al. Gen Thorac Cardiovasc Surg. 2021;69(5):897-901. Read it
9. Shimizu K, et al. Kobe J Med Sci. 2021;66(5):E166-9. Read it
10. Ferraz L, et al. Br J Cardiol. 2023;30(1):4. Read it
11. ACOG Committee Opinion No. 775: Nonobstetric surgery during pregnancy. Obstet Gynecol. 2019;133(4):e285-6. Read it
12. De Backer J, et al. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy. Eur Heart J. 2025;46(43):4462-568. Read it
13. Epidural leaflet (WAHT-PI-309). Worcestershire Acute Hospitals NHS Trust. [cited 2026 Oct 20]. Read it
14. Moossdorff M, et al. Eur Heart J Case Rep. 2021;5(10):ytab373. Read it
15. ACOG Committee Opinion No. 804: Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2020;135(4):e178-88. Read it
16. Exercise in pregnancy. NHS. Reviewed 2026 Sep 24 [cited 2026 Oct 20]. Read it
17. Reducing the risk of stillbirth. NHS. Reviewed 2024 Apr 24 [cited 2026 Oct 20]. Read it
18. ACOG Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210-6. Read it
19. Pregnancy and Marfan Syndrome. The Marfan Foundation. [cited 2026 Oct 20]. Read it
20. Urgent Maternal Warning Signs. CDC Hear Her. 2024 May 15 [cited 2026 Oct 20]. Read it