Prostacyclin-based regimens and phosphodiesterase-5 inhibitors improve survival in pregnant women with pulmonary hypertension when managed in specialized centers.
Does targeted pulmonary vasodilator therapy improve maternal and fetal outcomes in pregnant women with pulmonary hypertension?
Contemporary management of pulmonary hypertension in pregnancy using a multidisciplinary, prostacyclin-anchored approach in specialized centers improves maternal survival, though neonatal morbidity remains high.
Absolute Event Rate: 0% vs 0%
ABSTRACT Pulmonary hypertension (PH) in pregnancy remains one of the most challenging frontiers in maternal medicine. Despite modern therapeutic progress, it continues to carry a high risk of maternal and neonatal morbidity and mortality. This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, explored all available evidence on the management and outcomes of PH in pregnancy in the current therapeutic era. Comprehensive searches were performed across PubMed, Scopus, and Embase from 2005 through May 2025. Eligible studies included observational cohorts, registries, and systematic reviews reporting maternal or fetal outcomes under targeted pulmonary vasodilator therapy. From 1152 records screened, 33 studies met the inclusion criteria, encompassing more than 2500 pregnancies. Findings show a clear survival improvement when women are managed in specialized centers using prostacyclin-based regimens and phosphodiesterase-5 inhibitors, while teratogenic agents such as endothelin receptor antagonists and riociguat remain contraindicated. Integrated risk assessment combining echocardiographic parameters (tricuspid annular plane systolic excursion and RV strain) and biomarkers (N-terminal pro-brain natriuretic peptide and troponin) provides a practical framework for real-time clinical decision-making. Neonatal outcomes, although improved, still reflect high rates of preterm delivery and neonatal intensive care unit admission. Evidence synthesis supports a multidisciplinary, prostacyclin-anchored approach as the cornerstone of contemporary care. This review consolidates current therapeutic pathways and identifies the need for global registry collaboration, standardized preconception counseling, and translational research that bridges vascular biology with clinical perinatology to further improve outcomes for this high-risk population.
Andonotopo et al. (Tue,) reported a other. Prostacyclin-based regimens and phosphodiesterase-5 inhibitors improve survival in pregnant women with pulmonary hypertension when managed in specialized centers.
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