Evaluation of maternal and fetal outcomes in pregnancy complicated with pulmonary arterial hypertension.

Abstract

Pulmonary arterial hypertension (PAH) is an uncommon type of pulmonary hypertension (PH) disease characterized by progressive remodeling of distal pulmonary arteries. It could inevitably lead to pulmonary vascular resistance and even right ventricular failure. Biologists have explored the basic pathobiology of PAH, but its functional mechanism and effect in pregnant people remain unknown. This study was designed to investigate the maternal and fetal outcomes of pregnancy-related PAH. Clinical data of 59 pregnant women with PAH who were admitted to Peking Union Medical College Hospital from Jan. 2000 to Dec. 2018 were retrospectively reviewed and analyzed. Multiple parameters, including age, gestational week, the New York Heart Association (NYHA) cardiac functional classification, ultrasonic cardiogram (UCG), blood test, pregnancy complications, pulmonary arterial systolic pressure, maternal and fetal outcomes, were comprehensively investigated and analyzed. According to the pulmonary arterial systolic pressure, all 59 pregnant women were divided into mild PAH (30-49 mmHg, n=18), moderate PAH (50-79 mmHg, n=17) and severe PAH (>79 mmHg, n=24). Five patients died, and the mortality rate was 8.5%. Compared with the mild and moderate groups, the mean gestational week, age of the pregnancy, and NYHA cardiac functional classification grade in the severe PAH group were dramatically different (all P<0.05). The incidence of pregnancy-related complications in the severe PAH group was significantly higher than those in the mild and moderate PAH groups (both P<0.05). The blood parameters, PAH, and NYHA cardiac functional classification grade were significantly changed before and after surgery. We found that the severity of PAH was a major factor of maternal and fetal outcomes. Strengthening the nursing care for pregnant women with PAH is of great clinical significance.