Long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography: a retrospective cohort study in a single center from China

Weisi Lai; Yiling Ding; Lieming Wen

doi:10.1177/2045894020966876

Long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography: a retrospective cohort study in a single center from China

Pulm Circ. 2021 Feb 2;11(1):2045894020966876. doi: 10.1177/2045894020966876. eCollection 2021 Jan-Mar.

Authors

Weisi Lai¹, Yiling Ding¹, Lieming Wen²

Affiliations

¹ Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, Changsha, China.
² Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, China.

Abstract

Recent studies suggest that pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension. We aimed to evaluate the long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography in our clinical department. Pregnant women with pulmonary hypertension, diagnosed by a pulmonary systolic arterial pressure > 30 mmHg via echocardiography, who were admitted in our department for termination of pregnancy or delivery between 2004 and 2016 were included in this retrospective cohort study. Demographic characteristics, clinical histories, perinatal outcomes, and follow-up outcomes after discharge were reported. The primary outcome was survival of the pregnant women after discharge. A total of 88 pregnant women with pulmonary hypertension were included in this cohort study. The women were categorized into severe and moderate pulmonary hypertension groups according to their pulmonary systolic arterial pressure at admission. Women with severe pulmonary hypertension were significantly more likely to have deteriorated cardiac function and higher incidence of neonatal complications during the perinatal periods (p < 0.05). During a median follow-up of 26 months, the mortality rate was significantly higher in women with severe pulmonary hypertension (p < 0.05). However, the accumulated survival rate was >90% for women with moderate pulmonary hypertension within the follow-up period. Multivariate Cox regression analyses showed that poor cardiac function before pregnancy, irregular antenatal care, and hyperuricemia were independent mortality risk factors for women with pulmonary hypertension after discharge. In conclusion, the long-term survival of pregnant women with moderate pulmonary hypertension diagnosed by echocardiography was considered acceptable in this cohort. Our findings suggest that pregnancy might not be absolutely contraindicated in women with moderate pulmonary hypertension.

Keywords: long-term; mortality; pregnancy; pulmonary hypertension; retrospective cohort.