What is the clinical evidence from this study?

Study design: Observational. Population: Pulmonary arterial hypertension (n=5). Intervention: Pregnancy. Primary outcome: Maternal and neonatal mortality and severe complications.

July 5, 2021Open Access

Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension

Key Result

Pregnancy in women with well-controlled pulmonary arterial hypertension closely followed by a multidisciplinary team resulted in 100% successful deliveries without maternal or neonatal mortality.

Study Design

Type

Observational (n=5)

Multicenter

Structured PICO

Population

5 women with well-controlled pulmonary arterial hypertension who had 7 pregnancies, followed by a multidisciplinary team at a single center in Switzerland.

Exposure

Multidisciplinary management during pregnancy including PAH-targeted therapy (calcium channel blockers, phosphodiesterase type 5 inhibitors, prostacyclins), prophylactic anticoagulation, and planned cesarean section under spinal anesthesia.

Outcome

Maternal and neonatal outcomes, including complications, clinical worsening of PAH, and successful delivery.hard clinical

Women with well-controlled, low-risk pulmonary arterial hypertension may have favorable pregnancy outcomes when managed by a multidisciplinary expert team, challenging the absolute contraindication to pregnancy in this specific subgroup.

Limitations

Small number of patients
Retrospective design

Abstract

Introduction: Since pregnancy in women with pulmonary arterial hypertension (PAH) is associated with a high risk of morbidity and mortality, it is recommended that pregnancy should be avoided in PAH. However, some women with mild PAH may consider this recommendation as unsuitable. Unfortunately knowledge on pregnancy outcomes and best management of PAH during pregnancy is limited. Methods: Data from all women with PAH who were followed during pregnancy by a multidisciplinary team at a tertiary referral center for PAH and who delivered between 2004 and 2020 were retrospectively analyzed in a case series. PAH risk factor profiles including WHO functional class (WHO-FC), NT-pro-BNP, echocardiographic pulmonary arterial pressure (PAP) and right heart function were analyzed prior to, during and following pregnancy. Results: In seven pregnancies of five women with PAH (median age 29 (27; 31) years), there were no abortions or terminations. Five pregnancies were planned (all in WHO-FC I-II), two incidental (WHO-FC II, III). During pregnancy none of the women had complications or clinical worsening of PAH. After a median pregnancy duration of 37 1/7 weeks all gave birth to healthy babies by cesarean section in spinal anesthesia. During pregnancy, PAP tended to increase, whilst the course of WHO-FC and NT-pro-BNP were variable and no trend could be detected. Conclusion: Women with PAH with a low risk profile closely followed by a multidisciplinary team had a favorable course during and after pregnancy, resulting in successful deliveries of healthy newborns.

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