Pregnancy in pulmonary arterial hypertension: Midterm outcomes of mothers and offspring

Kamp, Jan C.; Kaisenberg, Constantin von; Greve, Susanne; Winter, Lotta; Park, Da-Hee; Fuge, Jan; Kühn, Christian; Hoeper, Marius M.; Olsson, Karen M.

doi:10.1016/j.healun.2020.12.002

Cited by 39 publications

(36 citation statements)

References 11 publications

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“…All women were closely followed in our center, gave birth to healthy children and no serious adverse events or relevant worsening of PAH occurred (mean follow-up 4 years and 2 months). Compared to other series ( 9 , 10 , 20 ), all pregnant PAH-patients in in the present report were in a low risk group before pregnancy onset according to current guidelines or REVEAL scores ( 1 ).…”

Section: Discussioncontrasting

confidence: 59%

“…In patients with PAH being in the intermediate to high risk group, labor, delivery and the post-partum period are associated with a high risk of mortality described up to 36% but with better outcomes in multidisciplinary PH-centers in recent years (1,9,10,28,29). As others, we recommended delivery by cesarian section in spinal anesthesia, as an expert team can be present, unforeseen hemodynamic threats during labor can be avoided (9,10,20,30). The first week of the post-partum period carries the greatest risk for maternal death (31).…”

Section: Discussionmentioning

confidence: 99%

“…In PAH-patients, the pulmonary vascular disease impairs a physiologic vasodilator response. This may lead to increased pulmonary vascular resistance and the imminent risk of right heart failure ( 10 , 21 ). Pregnancy may also uncover a previously undiagnosed PAH, as shown in a series from Sheffield, where 4/9 pregnant woman had a de-novo diagnosis of PAH discovered due to excessive dyspnea during pregnancy ( 9 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…The method of delivery, anesthesia and perinatal complications as well as the condition of the neonates were documented, including neonatal death, small for gestational age (under the 10th customized centile) ( 11 ), preterm deliveries (prior to 37 weeks of gestation) ( 12 ), low birth weight ( ≤ 2,500 g) ( 13 ) and need for admission of the newborn to the neonatal intensive care unit. Well-controlled PAH was defined as patients in low risk profile under PAH targeted therapy ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

“…Despite the enormous risks which pregnancy implicates in PAH for both, the patient and the fetus, some patients with mild symptoms and little impairment due to PAH in everyday life decide to become pregnant or to continue an incidental pregnancy. However, literature on the management and course of pregnancies in PAH is rare ( 1 , 9 , 10 ). The aim of the present retrospective study was to analyze outcomes of all pregnancies in women with PAH treated in Switzerland's largest expert center for pulmonary hypertension.…”

Section: Introductionmentioning

confidence: 99%

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Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension

et al. 2021

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Introduction: Since pregnancy in women with pulmonary arterial hypertension (PAH) is associated with a high risk of morbidity and mortality, it is recommended that pregnancy should be avoided in PAH. However, some women with mild PAH may consider this recommendation as unsuitable. Unfortunately knowledge on pregnancy outcomes and best management of PAH during pregnancy is limited.Methods: Data from all women with PAH who were followed during pregnancy by a multidisciplinary team at a tertiary referral center for PAH and who delivered between 2004 and 2020 were retrospectively analyzed in a case series. PAH risk factor profiles including WHO functional class (WHO-FC), NT-pro-BNP, echocardiographic pulmonary arterial pressure (PAP) and right heart function were analyzed prior to, during and following pregnancy.Results: In seven pregnancies of five women with PAH (median age 29 (27; 31) years), there were no abortions or terminations. Five pregnancies were planned (all in WHO-FC I-II), two incidental (WHO-FC II, III). During pregnancy none of the women had complications or clinical worsening of PAH. After a median pregnancy duration of 37 1/7 weeks all gave birth to healthy babies by cesarean section in spinal anesthesia. During pregnancy, PAP tended to increase, whilst the course of WHO-FC and NT-pro-BNP were variable and no trend could be detected.Conclusion: Women with PAH with a low risk profile closely followed by a multidisciplinary team had a favorable course during and after pregnancy, resulting in successful deliveries of healthy newborns.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension

et al. 2021

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Pulmonary Hypertension in Pregnancy

Zaidan,

Duarte

2024

Critical Care Obstetrics

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Maternal and fetal outcomes of pregnant women with pulmonary arterial hypertension associated with congenital heart disease in Beijing, China: A retrospective study

Liu

Zhang

et al. 2022

Pulm. circ.

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As pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) may increase maternal and fetal risk, this study explored the pregnancy outcomes of Chinese women with PAH-CHD. The clinical data of pregnant women with PAH-CHD admitted to the Beijing Anzhen Hospital from 2010 to 2019 were retrospectively analyzed; these patients and their offspring were followed up, with a mean period of 5.9 ± 2.7 years. Overall, 260 patients with PAH-CHD were included. The mean maternal age was 27.7 ± 4.1 years, and 205 (78.8%) patients were nulliparous. The estimated systolic pulmonary artery pressure was 40-50 mmHg in 34.6% of the patients, 50-70 mmHg in 23.1%, and >70 mmHg in 42.3%. More than 96% of patients were diagnosed with PAH-CHD before pregnancy. During pregnancy, heart failure occurred in 19.2% of the patients. Cesarean delivery was performed in 88.1% (15.0% emergency) of the patients. Complications included fetal distress (5.8%), preterm delivery (34.2%), and low birth weight (33.8%). A total of 15 mothers (5.8%) died, with the highest mortality rate in those with Eisenmenger syndrome (10/43, 23.3%), and 10 offspring died (3.8%), two (0.8%) following hospital discharge and eight (3.1%) while in hospital. Although most pregnant women with PAH-CHD were able to have children, PAH increased the maternal and fetal risk. Thus, an individualized risk-based approach with shared decision-making may be more appropriate in pregnant women with PAH-CHD.

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Pregnancy in pulmonary arterial hypertension: Midterm outcomes of mothers and offspring

Cited by 39 publications

References 11 publications

Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension

Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension

Pulmonary Hypertension in Pregnancy

Maternal and fetal outcomes of pregnant women with pulmonary arterial hypertension associated with congenital heart disease in Beijing, China: A retrospective study

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