title: Pregnancy outcomes in pulmonary arterial hypertension in the modern management era.
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 compiled a multinational, prospective registry to examine the contemporary outcome of pregnancies in patients with PAH. During a 3-yr period, the 13 participating centres reported 26 pregnancies. Three (12%) females died and one (4%) developed right heart failure requiring urgent heart-lung transplantation. There were eight abortions; two spontaneous and six induced. 16 (62%) pregnancies 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 pregnancy 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.
authors.affiliation: Univ. Paris-Sud, Faculté de Me´decine, Le Kremlin-Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jaïs
authors.forename: Karen M
authors.initials: KM
authors.lastname: Olsson
authors.forename: Joan A
authors.initials: JA
authors.lastname: Barbera
authors.forename: Isabel
authors.initials: I
authors.lastname: Blanco
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
authors.forename: Andrew
authors.initials: A
authors.lastname: Peacock
authors.forename: C Dario
authors.initials: CD
authors.lastname: Vizza
authors.forename: Peter
authors.initials: P
authors.lastname: Macdonald
authors.forename: Marc
authors.initials: M
authors.lastname: Humbert
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data; D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D016041:Heart-Lung Transplantation / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000453:epidemiology*; D008428:Maternal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D014655:Vascular Resistance; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents