Why the study?
Pregnancy in patients with pulmonary artery hypertension carries high morbidity and mortality, but there are no published reports on using oral prostacyclins and prostacyclin receptor agonists during pregnancy.
Does selexipag improve outcomes in pregnant patients with severe pulmonary artery hypertension?
Does selexipag improve outcomes in pregnant patients with severe pulmonary artery hypertension?
This case report describes the use of oral selexipag in a pregnant patient with severe PAH who refused IV therapy, noting stability during pregnancy but fatal postpartum heart failure.
Offers potential oral option in high-risk PAH pregnancy; extends IV epoprostenol reports but leaves open safety/efficacy pending controlled data.
Pregnancy in patients with pulmonary artery hypertension (PAH) is associated with high mortality and morbidity. Despite the risks, more patients with PAH are becoming pregnant. Case reports and case series have described the use of IV epoprostenol in these patients with some success. However, there are no published reports regarding the use of oral prostacyclins and prostacyclin receptor agonists in pregnancy. We describe the use of selexipag, an oral prostacyclin receptor agonist, for treating severe PAH during pregnancy in a patient who refused IV prostacyclin therapy. She remained stable throughout pregnancy and delivered a healthy baby girl; however, she died 13 days after her delivery by cesarean section due to developing worsening heart failure. While there is data and support for IV prostacyclins in pregnancy, patients may opt for oral formulations, like in our case. Registry data on the use of oral prostacyclins and prostacyclin receptor agonists in pregnancy may help improve patient outcomes.
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Khan et al. (2023) studied this question.
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