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Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era

Pregnancy is hazardous with pulmonary arterial hypertension, but maternal mortality may have fallen in recent years. We sought to systematically evaluate pulmonary arterial hypertension and pregnancy-related outcomes in the last decade. We searched for articles describing outcomes in pregnancy cohor...

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Autores principales: Low, Ting-Ting, Guron, Nita, Ducas, Robin, Yamamura, Kenichiro, Charla, Pradeepkumar, Granton, John, Silversides, Candice K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172332/
https://www.ncbi.nlm.nih.gov/pubmed/34104423
http://dx.doi.org/10.1177/20458940211013671
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author Low, Ting-Ting
Guron, Nita
Ducas, Robin
Yamamura, Kenichiro
Charla, Pradeepkumar
Granton, John
Silversides, Candice K
author_facet Low, Ting-Ting
Guron, Nita
Ducas, Robin
Yamamura, Kenichiro
Charla, Pradeepkumar
Granton, John
Silversides, Candice K
author_sort Low, Ting-Ting
collection PubMed
description Pregnancy is hazardous with pulmonary arterial hypertension, but maternal mortality may have fallen in recent years. We sought to systematically evaluate pulmonary arterial hypertension and pregnancy-related outcomes in the last decade. We searched for articles describing outcomes in pregnancy cohorts published between 2008 and 2018. A total of 3658 titles were screened and 13 studies included for analysis. Pooled incidences and percentages of maternal and perinatal outcomes were calculated. Results showed that out of 272 pregnancies, 214 pregnancies advanced beyond 20 gestational weeks. The mean maternal age was 28 ± 2 years, mean pulmonary artery systolic pressure on echocardiogram was 76 ± 19 mmHg. Etiologies include idiopathic pulmonary arterial hypertension (22%), congenital heart disease (64%), and others (15%). Majority (74%) had good functional class I/II. Only 48% of women received pulmonary arterial hypertension-specific therapy. Premature deliveries occur in 58% of pregnancies at mean of 34 ± 1 weeks, most (76%) had Cesarean section. Maternal mortality rate was 12% overall (n = 26); even higher for idiopathic pulmonary arterial hypertension etiology alone (20%). Reported causes of death included right heart failure, cardiac arrest, pulmonary arterial hypertension crises, pre-eclampsia, and sepsis; 61% of maternal deaths occur at 0–4 days postpartum. Stillbirth rate was 3% and neonatal mortality rate was 1%. In conclusion, pulmonary arterial hypertension in pregnancy continues to be perilous with high maternal mortality rate. Continued prospective studies are needed.
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spelling pubmed-81723322021-06-07 Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era Low, Ting-Ting Guron, Nita Ducas, Robin Yamamura, Kenichiro Charla, Pradeepkumar Granton, John Silversides, Candice K Pulm Circ Review Article Pregnancy is hazardous with pulmonary arterial hypertension, but maternal mortality may have fallen in recent years. We sought to systematically evaluate pulmonary arterial hypertension and pregnancy-related outcomes in the last decade. We searched for articles describing outcomes in pregnancy cohorts published between 2008 and 2018. A total of 3658 titles were screened and 13 studies included for analysis. Pooled incidences and percentages of maternal and perinatal outcomes were calculated. Results showed that out of 272 pregnancies, 214 pregnancies advanced beyond 20 gestational weeks. The mean maternal age was 28 ± 2 years, mean pulmonary artery systolic pressure on echocardiogram was 76 ± 19 mmHg. Etiologies include idiopathic pulmonary arterial hypertension (22%), congenital heart disease (64%), and others (15%). Majority (74%) had good functional class I/II. Only 48% of women received pulmonary arterial hypertension-specific therapy. Premature deliveries occur in 58% of pregnancies at mean of 34 ± 1 weeks, most (76%) had Cesarean section. Maternal mortality rate was 12% overall (n = 26); even higher for idiopathic pulmonary arterial hypertension etiology alone (20%). Reported causes of death included right heart failure, cardiac arrest, pulmonary arterial hypertension crises, pre-eclampsia, and sepsis; 61% of maternal deaths occur at 0–4 days postpartum. Stillbirth rate was 3% and neonatal mortality rate was 1%. In conclusion, pulmonary arterial hypertension in pregnancy continues to be perilous with high maternal mortality rate. Continued prospective studies are needed. SAGE Publications 2021-05-14 /pmc/articles/PMC8172332/ /pubmed/34104423 http://dx.doi.org/10.1177/20458940211013671 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review Article
Low, Ting-Ting
Guron, Nita
Ducas, Robin
Yamamura, Kenichiro
Charla, Pradeepkumar
Granton, John
Silversides, Candice K
Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era
title Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era
title_full Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era
title_fullStr Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era
title_full_unstemmed Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era
title_short Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era
title_sort pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172332/
https://www.ncbi.nlm.nih.gov/pubmed/34104423
http://dx.doi.org/10.1177/20458940211013671
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