Key result
Pregnancy in women with pulmonary arterial hypertension carries an increased risk of maternal and fetal complications and death, prompting recommendations for pregnancy avoidance or early termination.
This review outlines the physiologic challenges, current consensus recommendations, and management strategies for pregnant women with pulmonary arterial hypertension, emphasizing that pregnancy avoidance or early termination remains recommended due to high maternal and fetal risks.
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Heightened maternal-fetal risks in PAH pregnancy warrant specialized counseling; Level 4 data leave optimal management strategies open.
Pulmonary arterial hypertension (PAH) is a pulmonary vasculopathy associated with abnormal cardiopulmonary hemodynamics and a limited life expectancy due to right heart failure. Young women are preferentially affected. Women with PAH are at increased risk of complications and death during pregnancy for both the mother and the fetus. While it is not well characterized how changes in sex steroids and other hormones during pregnancy affect pulmonary hypertension, many expected systemic and heart–lung physiologic adaptations during gestation are poorly tolerated in women with PAH. Despite the approval of numerous therapies for PAH in recent years, pregnancy avoidance or early termination is still recommended in women with PAH because of poor outcomes. In this review, we will discuss physiologic and hormonal changes in pregnancy as they relate to pulmonary vascular disease and right heart function. We will review current consensus recommendations and outline the management of pregnancy in PAH when it does occur.
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Banerjee et al. (2017) conducted a review in Pulmonary arterial hypertension in pregnancy. Pregnancy was evaluated. Pregnancy in women with pulmonary arterial hypertension carries an increased risk of maternal and fetal complications and death, prompting recommendations for pregnancy avoidance or early termination.
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