Key result
Pregnancy in PAH carries up to ~25% maternal mortality and requires prevention or expert care.
Why the study?
This study aims to describe the pathophysiology of pregnancy in pulmonary hypertension and review recent literature on maternal and fetal outcomes.
Despite advances in management, pregnancy in pulmonary arterial hypertension remains an extremely high-risk condition with significant maternal and fetal mortality, and pregnancy avoidance is recommended.
Supports expert-center counseling for PAH pregnancies; leaves open prospective data on modern therapies.
Purpose of review This study aims to describe the pathophysiology of pregnancy in pulmonary hypertension (PH) and review recent literature on maternal and fetal outcomes. Recent findings There is an increasing number of pregnant women with PH. Maternal mortality in pulmonary arterial hypertension (PAH) ranges from 9 to 25%, most commonly from heart failure and arrythmias. The highest risk of death is peri-partum and post-partum. Fetal/neonatal morbidity and mortality are also substantial. There are high rates of prematurity, intrauterine growth retardation, and preeclampsia. Women should be referred to expert centers for management. Combination PAH therapy with parenteral prostacyclin and a phosphodiesterase type V inhibitor is recommended. Induced vaginal delivery is preferred, except in cases of severe heart failure or obstetric indications for cesarean section. Summary Despite advances in management, pregnancy in PAH remains a high-risk condition and should be prevented.
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Krishnan et al. (2021) conducted a review in Pulmonary hypertension in pregnancy. Pregnancy in pulmonary arterial hypertension remains a high-risk condition with maternal mortality ranging from 9 to 25%, and should be prevented or managed at expert centers.
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