Abstract
Previous studies have reported mortality rates of up to 56% associated with pregnancy in pulmonary arterial hypertension (PAH) but the management of this disease has changed considerably in recent years.
We conducted a multinational, prospective registry to examine the contemporary outcome of pregnancies in patients with PAH.
During a 3-year period, the 13 participating centres reported 26 pregnancies. Three females (12%) died and one (4%) developed right heart failure requiring urgent heart-lung transplantation. There were 8 abortions; 2 spontaneous and 6 induced. Sixteen pregnancies (62%) were successful, i.e. the females delivered healthy babies without complications. These females had well controlled PAH (pulmonary vascular resistance, PVR, 500±352 dyn.s.cm−5); eight of them were long-term responders to calcium channel blockers. In contrast, the females who died or required transplantation had poorly controlled PAH (PVR, 1,667±209 dyn.s.cm−5).
Pregnancy remains associated with a substantial mortality rate in PAH. However, our results indicate that the outcome of pregnancies in PAH has improved, at least when PAH is well controlled and particularly in long-term responders to calcium channel blockers. These data must be confirmed by larger series before the general recommendation to avoid pregnancy in all patients with PAH is reconsidered.
- ERS
