Key result
Severe pulmonary hypertension in pregnant women was associated with a significantly lower 5-year survival rate after discharge compared to moderate pulmonary hypertension (35.0% vs 90.0%, p=0.001).
Why the study?
Recent studies suggested pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension, but long-term outcomes in pregnant women diagnosed by echocardiography needed evaluation.
Does severe pulmonary hypertension compared to moderate pulmonary hypertension worsen long-term survival in pregnant women?
Cohort (n=88)
No
Does severe pulmonary hypertension compared to moderate pulmonary hypertension worsen long-term survival in pregnant women?
Pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension, as they demonstrated an acceptable 90% cumulative 5-year survival rate, whereas severe pulmonary hypertension remains associated with high mortality.
Recent studies suggest that pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension. We aimed to evaluate the long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography in our clinical department. Pregnant women with pulmonary hypertension, diagnosed by a pulmonary systolic arterial pressure > 30 mmHg via echocardiography, who were admitted in our department for termination of pregnancy or delivery between 2004 and 2016 were included in this retrospective cohort study. Demographic characteristics, clinical histories, perinatal outcomes, and follow-up outcomes after discharge were reported. The primary outcome was survival of the pregnant women after discharge. A total of 88 pregnant women with pulmonary hypertension were included in this cohort study. The women were categorized into severe and moderate pulmonary hypertension groups according to their pulmonary systolic arterial pressure at admission. Women with severe pulmonary hypertension were significantly more likely to have deteriorated cardiac function and higher incidence of neonatal complications during the perinatal periods (p < 0.05). During a median follow-up of 26 months, the mortality rate was significantly higher in women with severe pulmonary hypertension (p < 0.05). However, the accumulated survival rate was >90% for women with moderate pulmonary hypertension within the follow-up period. Multivariate Cox regression analyses showed that poor cardiac function before pregnancy, irregular antenatal care, and hyperuricemia were independent mortality risk factors for women with pulmonary hypertension after discharge. In conclusion, the long-term survival of pregnant women with moderate pulmonary hypertension diagnosed by echocardiography was considered acceptable in this cohort. Our findings suggest that pregnancy might not be absolutely contraindicated in women with moderate pulmonary hypertension.
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Lai et al. (2021) conducted a cohort in Pulmonary hypertension in pregnancy (n=88). Severe pulmonary hypertension (PSAP ≥ 50 mmHg) vs. Moderate pulmonary hypertension (PSAP 30-49 mmHg) was evaluated on Survival of the pregnant women after discharge (5-year cumulative survival) (p=0.001). Severe pulmonary hypertension in pregnant women was associated with a significantly lower 5-year survival rate after discharge compared to moderate pulmonary hypertension (35.0% vs 90.0%, p=0.001).
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