Multidisciplinary care at a specialist center is essential for pregnant patients with pulmonary arterial hypertension to manage high maternal morbidity and mortality risks.
This review outlines the multidisciplinary management of pregnancy in patients with pulmonary arterial hypertension, emphasizing the high risks and the need for specialized care.
Pulmonary arterial hypertension (PAH) is a vasoconstrictive disease of the distal pulmonary vasculature resulting in adverse right heart remodeling. Pregnancy in PAH patients is associated with high maternal morbidity and mortality as well as neonatal and fetal complications. Pregnancy-associated changes in the cardiovascular, pulmonary, hormonal, and thrombotic systems challenge the complex PAH physiology. Due to the high risks, patients with PAH are currently counseled against pregnancy based on international consensus guidelines, but there are promising signs of improving outcomes, particularly for patients with mild disease. For patients who become pregnant, multidisciplinary care at a PAH specialist center is needed for peripartum monitoring, medication management, delivery, postpartum care, and complication management. Patients with PAH also require disease-specific counseling on contraception and breastfeeding. In this review, we detail the considerations for reproductive planning, pregnancy, and delivery for the multidisciplinary care of a patient with PAH.
Coursen et al. (2022) conducted a review in Pulmonary arterial hypertension in pregnancy. Multidisciplinary care was evaluated. Multidisciplinary care at a specialist center is essential for pregnant patients with pulmonary arterial hypertension to manage high maternal morbidity and mortality risks.