Pulmonary hypertension and pregnancy outcomes: Systematic Review and Meta-analysis

Jha, Nivedita; Jha, Ajay Kumar; Mishra, Sandeep Kumar; Sagili, Haritha

doi:10.1016/j.ejogrb.2020.08.028

Cited by 21 publications

(19 citation statements)

References 34 publications

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“…Occurring mostly in women of childbearing age, PAH will cause intimal hyperplasia of the pulmonary arteries, autochthonous thrombus, and increased pulmonary vascular resistance, ultimately increasing the right heart load of patients and leading to heart failure or death in severe cases. Both secondary PAH and primary PAH are absolute contraindications of pregnancy because patients in pregnancy will undergo a series of physiological changes that will greatly increase the mortality and the incidence of adverse pregnancy outcomes [ 6 , 12 – 14 ]. For the patients, changes during pregnancy include increased blood volume, physiological anemia, the abnormal cardiac output that can increase by about 50%, and a hypercoagulable state in the body of patients.…”

Section: Discussionmentioning

confidence: 99%

“…With the continuous optimization of medical technology in recent years, the perinatal mortality rate of PAH has decreased from 33%–42% to 4.2%–15.0% [ 4 ], indicating an increased survival rate of patients. However, for patients with Eisenmenger syndrome, the mortality rate remains about 25% [ 5 , 6 ], suggesting a high possibility of adverse pregnancy outcomes. At present, Western medicine treatment is often adopted to improve the hemodynamics of patients in practice, and targeted PAH drugs are gradually introduced, including anticoagulant drugs such as sildenafil citrate to alleviate the hypercoagulable state of patients and enhance their cardiopulmonary function.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Yiqi Buxue Decoction on Hemodynamic Changes of the Uterine Artery and Fetal Umbilical Artery and Pregnancy Outcomes in Pregnant Patients with Pulmonary Arterial Hypertension

Han

Gao

Sun

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the effect of Yiqi Buxue decoction on hemodynamic changes of the uterine artery and fetal umbilical artery and pregnancy outcomes in pregnant patients with pulmonary arterial hypertension (PAH). Methods. 120 pregnant patients with PAH treated in our hospital (January 2019-January 2020) were chosen as the research objects, and randomly split into group A (n = 60) and group B (n = 60). Both groups received routine treatment, and group B was treated with sildenafil citrate, while group A was treated with Yiqi Buxue decoction combined with sildenafil citrate. Both groups received 6 weeks of treatment to analyze the hemodynamic changes of the uterine artery and fetal umbilical artery and compare the cardiopulmonary function indexes and pregnancy outcomes between the two groups. Results. The hemodynamic indexes of the uterine artery and fetal umbilical artery, cardiopulmonary function indexes, and pregnancy outcomes in group A after treatment were notably better compared with group B ( P < 0.01 ). Conclusion. Yiqi Buxue decoction can stabilize the hemodynamics of pregnant patients with PAH, improve their cardiopulmonary function, alleviate hypotension, and thus, reduce the possibility of adverse pregnancy outcomes, which should be popularized in practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Yiqi Buxue Decoction on Hemodynamic Changes of the Uterine Artery and Fetal Umbilical Artery and Pregnancy Outcomes in Pregnant Patients with Pulmonary Arterial Hypertension

Han

Gao

Sun

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…Numerous clinical studies have paid much attention to the treatment and management of mothers, as well as fetal birth outcomes. As was reported, the adverse birth outcomes of pregnancy with PH included premature delivery, low birth weight (LBW), small for gestational age (SGA), intrauterine growth restriction (IUGR), and even death ( Duan et al, 2016 ; Sliwa et al, 2016 ; Keepanasseril et al, 2019 ; Jha et al, 2020 ). Inspiringly, it has been noted that pregnancy outcomes are improved due to multidisciplinary cooperation ( Rezk and Gamal 2016 ).…”

Section: Introductionmentioning

confidence: 88%

Targeting Myadm to Intervene Pulmonary Hypertension on Rats Before Pregnancy Alleviates the Effect on Their Offspring’s Cardiac-Cerebral Systems

et al. 2022

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Pregnancy with pulmonary hypertension (PH) seriously threatens the life and safety of mothers and infants. Here, the long-term effect of maternal PH on the postpartum growth of rat offspring was focused for the first time, as well as explored the role of Myadm in PH rats before pregnancy based upon the previous findings. Patients with PH are prone to hypoxemia, leading to insufficient placental structure and function, which affects the organ function of fetuses, followed by evidence that differently expressed genes (DEGs) existed in the heart of maternal PH newborn rats and enriched in pathways related to cardiac and nerve development on human infants with similar birth outcome: low birth weight (LBW). LBW was one of the possible birth outcomes of pregnancy with PH, especially severe PH, accompanied by evidence that offspring derived from mothers with PH presented lower birth weights and slower growth rates than those derived from normal control mothers in a rat model. Besides, maternal PH rat offspring showed cardiac remodeling and a significant elevation of the expression levels of hypoxia- and inflammation-related markers in the cerebral cortex at both 10 and 14 weeks of age, respectively. What is more, the previous studies found that the overexpression of Myadm could result in the remodeling of the pulmonary artery. And targeting Myadm to intervene PH before pregnancy could alleviate sustained low weight growth in maternal PH rat offspring, and the pathological changes of the cardiac–cerebral system caused by maternal PH, including enlarged right heart cavity, loss of cardiomyocytes, abnormal heart index, as well as cerebral cortex hypoxia and the inflammatory state as they grew up to a certain extent. The findings show the pathological significance of maternal PH on offspring growth and the cardiac–cerebral development in a rat model, as well as point out the potential treatment target, which may provide a further reference for pregnancy outcomes in women with PH and healthy development of offspring to some extent.

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“…[5][6][7][8] Pregnancy in patients with SLE-PAH is recognised as a serious and complicated scenario as it can result in negative consequences for both mothers and neonates, especially maternal death. [9][10][11][12] Additionally, few publications and guidelines have focused on decision-making and management of pregnancy in women with SLE-PAH. Several recent case reports have shown that pregnancy is feasible in patients with SLE-PAH.…”

Section: Key Messagesmentioning

confidence: 99%

Impact of pregnancy in patients with systemic lupus erythematosus-associated pulmonary arterial hypertension: case series and literature review

Tian

Qian

et al. 2022

Lupus Sci Med

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ObjectiveThis study aimed to investigate the clinical characteristics and outcomes of pregnancy complicated by SLE-associated pulmonary arterial hypertension (SLE-PAH) in a case series and literature review.MethodsThis single-centre retrospective study included 10 consecutive pregnancies complicated by SLE-PAH confirmed by right heart catheterisation (RHC) at Peking Union Medical College Hospital between 2009 and 2020. A literature search was conducted and 14 pregnancy cases complicated by SLE-PAH were reviewed.ResultsAt the time of 10 patients’ initial visits, the average age was 30.00±5.72 years and the median disease duration of SLE and PAH was 34.5 (range 1–164) months and 2 (1–51) months. Two patients carried planned pregnancy, seven patients developed PAH during pregnancy and one pregnancy was unplanned. Further, nine patients had low disease activity, with Systemic Lupus Erythematosus Disease Activity Index between 0 and 4, and 30%, 30% and 40% of patients were of WHO functional class II, III and IV, respectively. All patients were evaluated by RHC and echocardiography. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were elevated in 70% of patients, with a median level of 776 (56–18 023) pg/mL. The median time of completed pregnancies in all patients was 31 (15–38) weeks and six patients delivered live infants. SLE activity and PAH severity improved in 70% of patients within 6 months after delivery. One patient died on the 15th day after induction of labour. In the remaining patients, all achieved a lupus low disease activity state; according to the European Society of Cardiology/European Respiratory Society risk stratification, seven were categorised at a lower risk state compared with their risk stratification during pregnancy, and two remained at intermediate risk. Additionally, 80% of patients exhibited mild impairments with WHO functional class I or II. The median NT-proBNP level was 184 (32–4003) pg/mL within 6 months after delivery. In the reviewed literature, the average age of patients was 30.09±5.37 years. The median time of completed pregnancies was 36 (28–40) weeks. More cases were planned and successful, and the survival rates of mothers and neonates were 85.71% and 92.86%, respectively.ConclusionsSuccessful pregnancy could be possible in women with SLE-PAH if SLE-PAH treatment goals are achieved under proper therapies, careful monitoring and thorough evaluations.

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Pulmonary hypertension and pregnancy outcomes: Systematic Review and Meta-analysis

Cited by 21 publications

References 34 publications

Effect of Yiqi Buxue Decoction on Hemodynamic Changes of the Uterine Artery and Fetal Umbilical Artery and Pregnancy Outcomes in Pregnant Patients with Pulmonary Arterial Hypertension

Effect of Yiqi Buxue Decoction on Hemodynamic Changes of the Uterine Artery and Fetal Umbilical Artery and Pregnancy Outcomes in Pregnant Patients with Pulmonary Arterial Hypertension

Targeting Myadm to Intervene Pulmonary Hypertension on Rats Before Pregnancy Alleviates the Effect on Their Offspring’s Cardiac-Cerebral Systems

Impact of pregnancy in patients with systemic lupus erythematosus-associated pulmonary arterial hypertension: case series and literature review

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