What is the clinical evidence from this study?

Study design: Observational. Population: Pulmonary hypertension in pregnancy (n=154). Primary outcome: Maternal mortality (p=<0.001).

January 9, 2023Open Access

Pregnancy outcomes in women with pulmonary hypertension: a retrospective study in China

Q: What are the key findings of this study?

Among pregnant women with pulmonary hypertension, overall maternal mortality was 3.2%, with the highest mortality rate of 50% observed in patients with idiopathic pulmonary arterial hypertension.

Key Result

Among pregnant women with pulmonary hypertension, overall maternal mortality was 3.2%, with the highest mortality rate of 50% observed in patients with idiopathic pulmonary arterial hypertension.

Study Design

Type

Observational (n=154)

Multicenter

Structured PICO

Population

154 pregnant women with pulmonary hypertension (PH) admitted to a single center in China between January 2011 and December 2020.

Outcome

Maternal-foetal outcomes including maternal mortality, ICU admission, heart failure during pregnancy, and neonatal outcomes (premature, low birth weight, neonatal mortality).hard clinical

Pregnancy in women with pulmonary hypertension carries significant maternal and fetal risks, with idiopathic PAH associated with particularly high maternal mortality (50%).

Main Result

p-value: p=<0.001

Limitations

Single-center retrospective investigation with a limited sample size, which may introduce bias in population representation.
Diagnosis of pulmonary hypertension was primarily based on cardiac color Doppler ultrasonography rather than right heart catheterization.

Abstract

BACKGROUND: In recent years, with the development of monitoring conditions and the application of pulmonary vascular-targeted drugs, pregnancy outcomes in women with pulmonary hypertension (PH) have improved, but the maternal mortality rate is still high. The purpose of this study was to describe the maternal-foetal outcomes in pregnant women with PH. METHODS: The clinical data of 154 pregnant women with PH who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 2011 to December 2020 were collected and descriptively analysed. RESULTS: Among the 154 pregnant women with PH, 6 (3.9%) had idiopathic pulmonary arterial hypertension (iPAH), 41 (26.6%) had pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH), 45 (29.2%) had PAH related to other diseases (oPAH), and 62 (40.3%) had PH related to left heart disease (LHD-PH). The systolic pulmonary artery pressure (sPAP) was 36-49 mmHg in 53.2% of the patients, 50-69 mmHg in 22.1% of the patients and ≥ 70 mmHg in 24.7% of the patients. Five (3.2%) pregnant women died within 1 week after delivery; iPAH patients had the highest mortality rate (3/6, 50%). Fifty-four patients (35.1%) were admitted to the intensive care unit (ICU), and the incidence of heart failure during pregnancy was 14.9%. A total of 70.1% of the patients underwent caesarean section; 42.9% had premature infants; 28.6% had low-birth-weight (LBW) infants; 13.0% had very-low-birth-weight (VLBW) infants; 3.2% had extremely-low-birth-weight (ELBW) infants; 61% had small for gestational age (SGA) infants; and 1.9% experienced neonatal mortality. CONCLUSION: There were significant differences in the maternal-foetal outcomes in the iPAH, CHD-PAH, oPAH and LHD-PH groups. Maternal mortality was highest in the iPAH group; therefore, iPAH patients should be advised to prevent pregnancy. Standardized and multidiscipline-assisted maternal management is the key to improving maternal-foetal outcomes.

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