Is the maternal risk of pregnancy acceptable in patients with moderate pulmonary hypertension?

Abstract

We read with great interest a recent study by Weisi Lai et al., published in the journal of Pulmonary Circulation (1). The authors concluded that pregnancy carried favorable outcomes in women with moderate pulmonary hypertension (PH), diagnosed by transthoracic echocardiography (TTE) (1). However, respectfully we believe this conclusion might be misleading because of multiple reasons: • Ignoring the underlying condition(s) leading to pulmonary hypertension • Using only TTE for diagnosis and staging of pulmonary hypertension in pregnant women • A wide patient inclusion time limit (2004-2016) • Administering medications with potentially hazardous effects on mother or fetus during pregnancy

Maternal and Fetal Outcomes in Pregnant Women with Pulmonary Arterial Hypertension: A Single-Center Experience and Review of Current Literature

“… 7 - 27 Late hospitalization, severity of PH, and utilization of general anesthesia have been reported as risk factors for maternal mortality. 1 , 7 - 28 Neonatal survival rates ranged from 87% to 89% in the offspring of pregnant PH patients. 7 - 17 Cyanosis poses a significant risk to the fetus, and a live birth is unlikely if oxygen saturation (sat % O 2 ) < 85%.…”

“…25 Despite the improvements in the current PAH treatment strategies over decades, recent reports from the Chinese population continue to document increased maternal mortality in pregnant women, 17 , 26 and this risk has been correlated with the severity of the background PH and complexity of structural heart diseases. 28 …”