Fetal Outcomes, Maternal Mortality Vary Among Pregnant Women With Different Types of PH

Among pregnant women with pulmonary hypertension (PH), maternal mortality was higher for those who had idiopathic pulmonary arterial hypertension (iPAH) vs women with PAH related to congenital heart disease (CHD-PAH) or other diseases (oPAH) or PH related to left heart disease (LHD-PH).

In general, researchers found significant differences in maternal-fetal outcomes among women with iPAH, CHD-PAH, oPAH, and LHD-PH.

“With the application of targeted drug therapy in recent years, the prognosis of PAH patients has been significantly improved,” they said. “However, some studies have shown that the mortality rate of patients with PH is still as high as 13% to 18% in the first year.”

This retrospective study, published in BMC Pregnancy and Childbirth, included clinical data of 154 pregnant women with PH admitted to the Third Affiliated Hospital of Guangzhou Medical University in China between January 2011 and December 2020.

The median (SD) age of these women was 30.9 (5.1) years, ranging from 21 to 46 years. Of this group, 6 (3.9%) had iPAH, 41 (26.6%) had CHD-PAH, 45 (29.2%) had oPAH, and 62 (40.3%) had LHD-PH. Systolic pulmonary artery pressure (sPAP) was 36 to 49 mm Hg in 53.2% of patients, 50 to 69 mm Hg in 22.1% of patients, and ≥ 70 mm Hg in 24.7% of patients.

The median gestational week during hospitalization was 35.5 weeks, ranging between 6 and 41 weeks for the whole group. Fifty-four women (35.1%) were admitted to the intensive care unit (ICU), with women in the iPAH group having the highest ICU admission rate at 83.3%, followed by the LHD-PH group (37.1%), the CHD-PAH group (36.6%), and the oPAH group (24.4%). The authors reported this difference as statistically significant (P < .05).

Additionally, 108 women (70.1%) underwent caesarean section, and the incidence of heart failure during pregnancy was 14.9%.

Pregnant women in the study also experienced the following:

• 42.9% had infants born prematurely
• 28.6% had infants with low birthweight
• 13.0% had infants with very low birthweight
• 3.2% had infants with extremely low birthweight
• 61% had infants small for gestational age
• 1.9% experienced neonatal mortality

Five pregnant women died within a week after delivery, and the 1-week postpartum mortality rate among pregnant women with PH overall was 3.2%. Although pregnant women with iPAH had the highest mortality rate of 50%, it is important to note this reflects 3 of 6 women, a very small sample size and a much smaller group compared with the other 3 groups included in the study.

“This study was a single-centre retrospective investigation conducted in China, with a limited sample of the study populations, and there may be bias in the population representation,” the authors noted. “Second, since our study population consisted of pregnant women, cardiac colour Doppler ultrasonography, but not heart catheterization, was used as a diagnostic tool. This is a common limitation of similar studies.”

Based on this study’s findings, which warrant further research with larger sample sizes, the authors suggested individuals with iPAH should try to avoid pregnancy. For those who are at high risk but want to carry out their pregnancy, they recommend consultation with a doctor as soon as possible and standardized treatment.

“At the same time, we suggest that comprehensive hospitals should establish multidisciplinary assistance teams, including obstetrics, cardiovascular medicine, critical medicine, anaesthesiology, and neonatology specialists,” the authors said. “Clinicians must balance the pros and cons of maternal and fetal outcomes and choose the most appropriate treatment plan to improve maternal and fetal pregnancy outcomes.”

Reference

Lv C, Huang Y, Liao G, Wu L, Chen D, Gao Y. Pregnancy outcomes in women with pulmonary hypertension: a retrospective study in China. BMC Pregnancy Childbirth. 2023;23(1):16. doi:10.1186/s12884-023-05353-7