Key result
Oral sildenafil shows no independent benefit for fetal adverse outcomes in pregnant CHD-PAH patients.
Why the study?
Maternal and fetal mortality in patients with CHD-PAH is high, but studies evaluating the effect of sildenafil on maternal and fetal clinical outcomes are few.
Does oral sildenafil reduce maternal mortality and fetal adverse outcomes in pregnant patients with congenital heart disease-associated pulmonary artery hypertension?
Cohort (n=68)
Does oral sildenafil reduce maternal mortality and fetal adverse outcomes in pregnant patients with congenital heart disease-associated pulmonary artery hypertension?
Oral sildenafil therapy appears safe and is associated with reduced unadjusted fetal adverse outcomes in pregnant patients with CHD-associated PAH, though underlying PAH severity remains a critical predictor of outcomes.
Answers are grounded in this paper and cite their sources.
May support lower fetal risks with sildenafil in CHD-PAH pregnancy; hypothesis-generating and requires prospective trials before practice change.
Background and Aim: Maternal and fetal mortality in patients with congenital heart disease-associated pulmonary artery hypertension (CHD-PAH) is reported to be quite high. Sildenafil is the standard of care in PAH. Studies on sildenafil in maternal and fetal clinical outcomes are few. This study aimed to determine the effect of oral sildenafil on the clinical outcomes of mothers and fetuses with CHD-PAH. Methods: This study was an observational study with a retrospective cohort method. Patient data were taken from the hospital registry and medical records of patients who met the research criteria from August 2015 to August 2022. Based on sildenafil treatment, subjects were divided into two groups: subjects with oral sildenafil and those without sildenafil. The research outcome was maternal mortality and a composite of fetal adverse outcomes, defined as fetal mortality, oligohydramnios, intrauterine growth retardation (IUGR), and small for gestational age. Results: There were 68 pregnant women who met research criteria, consisting of subjects with sildenafil ( n = 32) and without sildenafil ( n = 36). A composite of maternal and fetal adverse outcomes occurred in 24 subjects (35.3%). Subjects with oral sildenafil therapy were not associated with maternal mortality. Subjects with oral sildenafil therapy had a lower incidence of fetal adverse outcomes ( n = 7, 21.9%) as compared to those without sildenafil ( n = 25, 56.8%), P = 0.029. In the multivariate analysis, oral sildenafil therapy had a neutral impact on maternal mortality and fetal adverse outcomes. Other PAH therapy use was a significant independent predictor of maternal mortality. The PVR value was a significant independent predictor of fetal adverse outcomes. Conclusion: Oral sildenafil therapy was safe for pregnant CHD-associated PAH patients. Oral sildenafil therapy reduced fetal adverse outcomes, namely fetal mortality, oligohydramnios, fetal growth restriction, and small for gestational age infants, in patients with CHD-associated PAH. PAH severity had a significant impact on pregnancy outcome.
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Nahdi et al. (2026) conducted a cohort in Congenital heart disease-associated pulmonary artery hypertension in pregnancy (n=68). Oral sildenafil vs. No sildenafil was evaluated on Maternal mortality and a composite of fetal adverse outcomes (fetal mortality, oligohydramnios, IUGR, and small for gestational age) (p=0.029). Oral sildenafil therapy in pregnant patients with CHD-PAH was associated with fewer fetal adverse outcomes, though multivariate analysis showed a neutral impact.
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