Key result
Asthma-related hypoxemia and inflammation in pregnancy are linked to pulmonary vasoconstriction, RV strain, and subsequent PH.
Why the study?
During pregnancy, asthma, pulmonary hypertension, and peripartum cardiomyopathy may intersect through shared hypoxemic, inflammatory, and endothelial pathways, requiring integrated evidence across respiratory, cardiac, and obstetric disciplines.
Systematic Review
Establishes the first comprehensive framework uniting the mechanistic, clinical, and policy dimensions of the asthma-PH/PPCM overlap in pregnancy, proposing a new integrated care model.
Proposes integrated heart-lung-perinatal protocols for overlapping asthma-PH-PPCM cases; extends siloed evidence into a unified framework pending prospective validation.
Pregnancy presents a unique cardiopulmonary stress test, during which asthma, pulmonary hypertension (PH), and peripartum cardiomyopathy (PPCM) may intersect through shared hypoxemic, inflammatory, and endothelial pathways. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to integrate evidence across respiratory, cardiac and obstetric disciplines. Comprehensive searches of PubMed, Embase, Scopus, Cochrane Library grey sources up to May 2025 identified 1380 records. After duplicate removal and screening, 40 studies met the inclusion criteria; 20 high-quality core studies were synthesised using AMSTAR-2, ROBINS-I and Newcastle–Ottawa frameworks. Data were extracted independently by two reviewers and integrated narratively by mechanistic domain and clinical phase. The synthesis demonstrates that asthma-related hypoxemia, eosinophilic inflammation and oxidative stress potentiate pulmonary vasoconstriction and right-ventricular strain, bridging towards PH and PPCM. Maternal mortality in modern PH pregnancies remains elevated despite improved multidisciplinary management, while uncontrolled asthma is consistently associated with preterm birth and foetal growth restriction. A new Integrated Heart–Lung Perinatal Care Model is proposed, defining oxygenation targets, biomarker thresholds and team-based escalation criteria to harmonise obstetric, pulmonary and cardiac care. Research priorities include precision asthma phenotyping, validation of oxygen-target algorithms, AI-supported early detection of decompensation and policy frameworks for equitable access to specialised care. This review followed PRISMA 2020 but was not prospectively registered. It establishes the first comprehensive framework uniting the mechanistic, clinical and policy dimensions of the asthma–PH/PPCM overlap in pregnancy.
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Lukas et al. (2025) conducted a systematic review in Asthma, pulmonary hypertension, and peripartum cardiomyopathy in pregnancy. Asthma-related hypoxemia and inflammation in pregnancy potentiate pulmonary vasoconstriction and right-ventricular strain, bridging towards pulmonary hypertension across 40 reviewed studies.
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