Pathological airway issues frequently masquerade as more severe forms of the physiological respiratory and airway symptoms that many pregnant patients describe. Disorders of the airway are often exacerbated by pregnancy; persistent or worsening dyspnea must be investigated. Gold standard investigations that involve radiation exposure should be used appropriately for diagnosis and surveillance. Goitre is endemic in many countries and often worsens in pregnancy, which places the patient at risk for tracheomalacia. Idiopathic subglottic stenosis is a disease of women in the child-bearing years, and while easily treated, needs to be first diagnosed. Anterior mediastinal masses are unfortunately frequently missed as the presenting symptoms are ascribed to pregnancy changes. Airway changes in pregnancy lead to sleep-disordered breathing and are worsened by preeclampsia. The airway worsens in labor and can transform an awkward airway into a difficult one. Current airway management guidelines should be followed, with specificity for the pregnant patient, ensuring equivalent airway equipment and airway expertise are available for women with known airway issues. Finally, the pregnant patient with a known structural airway issues must be managed in a centre with access to airway experts, surgeons, and cardiopulmonary bypass or ECMO to ensure outcomes are good for both mother and baby.