Maternal and perinatal outcomes of pregnant women with echocardiographically high probability of pulmonary arterial hypertension

OBJECTIVE: This study aimed to describe maternal and perinatal outcomes among pregnant women with echocardiographically high probability of pulmonary arterial hypertension (PAH) managed at a quaternary center and to compare outcomes between women with and without cardiac complications (CC). METHODS: This retrospective cohort study included pregnant women with echocardiographically estimated high probability of PAH and managed at a referral center between 2015 and 2022. Clinical, obstetric, and neonatal outcomes were obtained from medical records. CC were defined as heart failure, pulmonary edema, arrhythmia, pulmonary embolism, or maternal death during pregnancy or up to 6 weeks postpartum. Outcomes were compared between women with and without CC. Receiver operating characteristic (ROC) curve analysis was performed as an exploratory analysis to assess the discriminatory ability of pulmonary artery systolic pressure (PASP) for CC. RESULTS: Sixty-two pregnancies in 60 women (mean age 24.5 ± 6.5 years) were analyzed. Eight pregnancies (12.9%) were electively terminated, while 54 (87.1%) continued. CC occurred in 11 pregnancies (17.7%), mainly heart failure. Four maternal deaths (6.5%) were recorded. Among ongoing pregnancies, the median gestational age at delivery was 37.1 weeks, and the median birthweight was 2445 g. Fetal growth restriction occurred in 27.7%, and 62.9% of deliveries were by cesarean section. Neonatal mortality was 5.5%. In exploratory analysis, a PASP threshold of 64 mmHg predicted CC with 91% sensitivity and 60% specificity (area under the curve = 0.749). CONCLUSION: Pulmonary arterial hypertension is a high-risk condition in pregnancy, with substantial maternal and perinatal complications. Although maternal mortality was lower than historically reported in similar settings, the incidence of CC remained considerable. PASP might reflect disease severity and shows exploratory discriminatory ability but requires cautious interpretation.