Abstract 12286: Pregnancy Outcomes in Pulmonary Hypertension With Congenital Heart Disease: A Multicenter Experience From 2220 Cases

Abstract

Background: Cardiovascular disease is a global burden for women’s health. Pregnancy with pulmonary hypertension associated with congenital heart disease (CHD-PH) is related to prohibitive maternal mortality. According to the latest AHA scientific statement, their pregnancies are contraindicated, regardless of their CHD diagnosis and PH severity. Considering the emerging population of CHD-PH reaching the child-bearing age, how to balance the maternal risk and patients’ reproductive rights remains understudied and under-recognised. Hypothesis: We assessed the hypothesis that if the mild CHD-PH patients have better pre-pregnancy cardiac situation, their pregnancies shouldn’t all be contraindicated. Methods: Patients were retrospectively included before March 2017 and 205 cases were prospectively collected after that time. Pregnancy with CHD-PH was subdivided into two subgroups based on the estimated SPAP measured by non-invasive echocardiography (30-50 mmHg as mild and >50 mmHg as moderate-to-severe). Results: Of 2220 completed pregnancies with CHD from 7 tertiary institutions, 729 women had CHD-PH (398 mild CHD-PH). Of PH patients, the main CHD diagnosis is shunt lesion (70.92%) and only 26.89% were surgically repaired. The mortality and incidence of heart failure were 2.60% and 21.81%, respectively. No dead case happened in mild CHD-PH. Independent risk factors of maternal cardiac events included brain natriuretic peptide level, NYHA class, ejection fraction (EF), unrepaired CHD, strict supervision, late antenatal visit, without MDT and the severity of PH(except for mild CHD-PH). Furthermore, after propensity score matching analysis, the no-PH and mild PH groups have no significant difference in the maternal and offspring outcomes. Consistency Analysis indicated that mild CHD-PH had lower cardiac incidence than level IV of the modified WHO, except when they were associated with NYHA III-IV or EF<50%. Conclusion: To conclude, pregnancy in women with CHD-PH continues to be associated with significant morbidity, although their mortality is relatively low. If the mild CHD-PH patients have better pre-pregnancy cardiac situation (EF>50% and NYHA I-II), their pregnancies shouldn’t all be contraindicated.