Abstract 13561: Does the Use of Advanced Therapies Improve Outcomes During Pregnancy and Post Partum Period in Patients With Group I Pulmonary Hypertension

Abstract

Introduction: Poor outcomes have been reported in Pregnant patients with WHO Group I Pulmonary Hypertension (PH) before the advent of PH targeted therapies. We performed a systematic review and meta-analysis with the goal of evaluating the association between mortality rates and PH targeted therapies in pregnant women with WHO group 1 PH. Methods: PubMed Database was searched with keywords “pulmonary hypertension”, “pregnancy” from inception to December 2020. Inclusion criteria: >10 pregnancies, maternal mortality reported and WHO Classification available. A meta-analysis was performed to evaluate the association between maternal death and treatment with PH targeted therapies in patients with WHO group 1 PH. All other WHO groups were excluded. Results: Seven studies, published between 1992 and 2016, including 91 patients with WHO group 1 PH met inclusion criteria and were analyzed. (Table 1) Most common etiologies were Idiopathic PH and Congenital Heart Disease. Mortality ranged from 8.3% to 36.3%. Use of PH targeted therapies ranged from 25% to 100%. There was a trend towards survival benefit with PH targeted therapies compared with no therapy. This trend was not statistically significant. Of all deaths reported (n=18), thirteen (72.2%) occurred postpartum. Conclusions: Mortality in pregnant patients with WHO group I PH remains high; most deaths were due to PH crisis and occurred postpartum. Increased monitoring in the postpartum period is likely warranted. Studies were retrospective with small sample sizes. Larger and higher quality studies are needed to determine if PH targeted therapies improve mortality in pregnant patients with WHO group I PH.