Therapeutic Evaluation of the Currently Safe Vasodilators Used in Gestational Management of Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) during pregnancy is one of the most severe and potentially lethal conditions of pulmonary vascular disease in pregnant women and is associated with high maternal morbidity and mortality. The aim of this study was to evaluate the clinical outcomes of the current vasodilators that are regarded as safe medications for the treatment of PAH during pregnancy, thereby highlighting the potential indications, effectiveness, improved symptoms, maternal and fetal safety associated with this cardiovascular condition. A systematic literature search was carried out by using PRISMA guidelines and searching through different databases of the current vasodilator therapies that are regarded as safe for the treatment of pregnant women with PAH that could provide findings of evidence on the health and clinical outcomes in terms of improved symptoms and hemodynamics without apparent chances of survival for both the mother and the fetus. A total of 22 relevant articles were included in the final review and analysis. Most of the pregnant women had caesarean sections. Most of the publications were case reports, and prostacyclin analogues (n = 12) and phosphodiesterase type 5 inhibitors (n = 12) were the most provided vasodilator therapies reported by the publications followed by calcium channel blockers (n = 6) and nitric oxide (n = 6). The current vasodilator therapies provide good clinical support and contribute to improve symptoms with favorable health outcomes, and increased chances of survival for both the mother and the fetus. However, the limited methodological quality and absence of controlled trials warrant caution. Further prospective studies are essential to determine optimal management strategies and improve maternal–fetal outcomes in this high-risk population.